Decrease of implantable cardioverter-defibrillator shock therapy in children: correlation with ICD programming and remote monitoring

medRxiv

Abstract

Abstract Background Implantable cardioverter defibrillator (ICD) therapy is effective in preventing sudden cardiac death in children. Unnecessary shocks should be avoided. ICD programming strategies and remote monitoring effective in preventing ICD shock therapy in adults have been applied in children Objectives To investigate the effect of ICD programming and remote monitoring on th incidence of ICD shock therapy in children. Methods Retrospective multi-center study, including children with transvenous or epicardial ICD implantation. During follow-up ICD-shocks, programming variables and use of remote monitoring were collected. Results One-hundred-sixteen children were included, median age 13.4 years (min-max 0.3-18), median follow-up 5.2 years (IQR 3.7-6.6). Fifty-three with an ICD implanted before 2010 and 63 after 2010. The total, appropriate and in appropriate annual shock rate decreased from 10.5% to 8% (difference in mean cumulative function (MCF) P=0.008), 7.8% to 5.8% (MCF P=0.036) and 4.3% to 2.6% (MCF P=0.28) respectively, without increase in cardiac related death. The VF zone was programmed higher (≥210 bpm) in patients before 2010 compared to after 2010 (76% vs 90%; P=0.142), in patients with versus without shocks (79% vs 89%; P=0.243) and at time of appropriate versus in appropriate shocks (86% vs 79%; P=0.0016). Remote monitoring was associated with a decrease of total shocks (MCF P=0.013) and appropriate shocks (MCF P=0.052). Conclusions The incidence of ICD shocks has significantly decreased in children with implantation after 2010. A higher programmed VF-zone and application of remote monitoring are correlated to this decrease and therefore justify its use in strategies to prevent unnecessary shocks in children.

Authors 15

1. Robin A. Bertels corresponding Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center;

2. Eric H. Boersma

   Erasmus MC

   Affiliation as printed

   Erasmus Medical Center;

3. Martijn D Zeggelaar

   Erasmus MC

   Affiliation as printed

   Erasmus Medical Center;

4. Sophie A.F van Dongen

   Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Erasmus Medical Center -Sophia Children's Hospital ; Cardiovascular Institute ; Department of Pediatric Cardiology ; Dr

5. Arend D.J. ten Harkel Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center;

6. Lieselot van Erven Aachen

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center;

7. Cynthia Smeding

   Erasmus MC

   Affiliation as printed

   Erasmus Medical Center;

8. Beatrijs Bartelds

   Erasmus MC

   Affiliation as printed

   Erasmus Medical Center;

9. Gert van den Berg

   Erasmus MC

   Affiliation as printed

   Erasmus Medical Center;

10. Ewout P. Boesaard

    Radboud University Medical Center

    Affiliation as printed

    Radboud University Medical Center;

11. Rohit E. Bhagwandien

    Erasmus MC

    Affiliation as printed

    Thoraxcenter - Erasmus MC;

12. Sing‐Chien Yap

    Erasmus MC

    Affiliation as printed

    Erasmus MC;

13. Reinoud E. Knops

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

    Affiliation as printed

    Amsterdam UMC, location AMC

14. Nico A. Blom Aachen

    Leiden University Medical Center

    Affiliation as printed

    Leiden University Medical Center;

15. Janneke A.E. Kammeraad

    Erasmus MC

    Affiliation as printed

    Erasmus Medical Center;