The SIDECAR project: S-IcD registry in European paediatriC and young Adult patients with congenital heaRt defects

Author:

Silvetti Massimo Stefano1ORCID,Bruyndonckx Luc23ORCID,Maltret Alice45ORCID,Gebauer Roman6,Kwiatkowska Joanna7ORCID,Környei László8ORCID,Albanese Sonia9ORCID,Raimondo Cristina14ORCID,Paech Christian6ORCID,Kempa Maciej10ORCID,Fésüs Gábor8ORCID,Knops Reinoud E211,Blom Nico Andreas212,Drago Fabrizio1ORCID

Affiliation:

1. Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS , Rome , Italy

2. Department of Paediatric Cardiology, Amsterdam University Medical Centers , Amsterdam , The Netherlands

3. Laboratory of Experimental Medicine and Paediatrics, University of Antwerp , Antwerp , Belgium

4. Department of Paediatric Cardiology Hopital Necker-Enfants Malades , Paris , France

5. Hopital Marie Lannelongue-M3C, GHPSJ, Université Paris Descartes , Paris , France

6. Department of Paediatric Cardiology, Heart Centre Leipzig, University of Leipzig, Leipzig , Germany

7. Department of Paediatric Cardiology and Congenital Heart Defects, Medical University of Gdansk, Gdansk , Poland

8. Gottsegen National Cardiovascular Center , Budapest , Hungary

9. Heart Surgery Team, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital IRCCS , Rome , Italy

10. Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk , Poland

11. Department of Paediatrics, Antwerp University Hospital , Edegem , Belgium

12. Department of Paediatric Cardiology, Leiden University Medical Center , Leiden , The Netherlands

Abstract

Abstract Aims Subcutaneous-implantable cardiac defibrillators (S-ICDs) are used increasingly to prevent sudden cardiac death in young patients. This study was set up to gain insight in the indications for S-ICD, possible complications, and their predictors and follow-up results. Methods and results A multicentre, observational, retrospective, non-randomized, standard-of-care registry on S-ICD outcome in young patients with congenital heart diseases (CHDs), inherited arrhythmias (IAs), idiopathic ventricular fibrillation (IVF), and cardiomyopathies (CMPs). Anthropometry was registered as well as implantation technique, mid-term device-related complications, and incidence of appropriate/inappropriate shocks (IASs). Data are reported as median (interquartile range) or mean ± standard deviation. Eighty-one patients (47% CMPs, 20% CHD, 21% IVF, and 12% IA), aged 15 (14–17) years, with body mass index (BMI) 21.8 ± 3.8 kg/m2, underwent S-ICD implantation (primary prevention in 59%). This was performed with two-incision technique in 81% and with a subcutaneous pocket in 59%. Shock and conditional zones were programmed at 250 (200–250) and 210 (180–240) b.p.m., respectively. No intraoperative complications occurred. Follow up was 19 (6–35) months: no defibrillation failure occurred, 17% of patients received appropriate shocks, 13% of patients received IAS (supraventricular tachycardias 40%, T-wave oversensing 40%, and non-cardiac oversensing 20%). Reprogramming, proper drug therapy, and surgical revision avoided further IAS. Complications requiring surgical revision occurred in 9% of patients, with higher risks in patients with three-incision procedures [hazard ratio (HR) 4.3, 95% confidence interval (95% CI) 0.5–34, P = 0.038] and BMI < 20 (HR 5.1, 95% CI 1–24, P = 0.031). Conclusion This multicentre European paediatric registry showed good S-ICD efficacy and safety in young patients. Newer implantation techniques and BMI > 20 showed better outcome.

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference20 articles.

1. Cardioverter-defibrillator in children and young patients with congenital heart disease. Time to define ICD selection. (edit.);Silvetti;Kardiol Pol,2020

2. Clinical experience of entirely subcutaneous implantable cardioverter-defibrillators in children and adults: cause for caution;Jarman;Eur Heart J,2012

3. Clinical experience of subcutaneous and transvenous implantable cardioverter defibrillators in children and teenagers;Pettit;PACE,2013

4. Implantable cardioverter defibrillator therapy in paediatric practice: a single-centre UK experience with focus on subcutaneous defibrillation;Griksaitis;Europace,2013

5. S-ICD: is it ready for use in children and young adults? A single-center study;Silvetti;Europace,2018

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