Premium
Prospective Evaluation of Defibrillation Threshold and Postshock Rhythm in Young ICD Recipients
Author(s) -
RADBILL ANDREW E.,
TRIEDMAN JOHN K.,
BERUL CHARLES I.,
WALSH EDWARD P.,
ALEXANDER MARK E.,
WEBSTER GREGORY,
CECCHIN FRANK
Publication year - 2012
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2012.03519.x
Subject(s) - medicine , defibrillation , defibrillation threshold , cardiology , implantable cardioverter defibrillator , prospective cohort study , atrioventricular block , population , environmental health
Background:Adaptation of implantable cardioverter defibrillator (ICD) systems to the needs of pediatric and congenital heart patients is problematic due to constraints of vascular and thoracic anatomy. An improved understanding of the defibrillation energy and postshock pacing requirements in such patients may help direct more tailored ICD therapy. We describe the first prospective evaluation of defibrillation threshold (DFT) and postshock rhythm in this population.Methods:We prospectively studied patients ≤60 kg at time of ICD intervention. DFTs were obtained using a binary search protocol with three VF inductions. Postshock pacing was programmed using a stepwise protocol, lowering the rate prior to each VF induction.Results:Twenty patients were enrolled: 11 had channelopathy, five congenital heart disease, and four cardiomyopathy. The median age was 16 years, median weight 48 kg. Twelve patients had a transvenous high‐voltage coil; eight had pericardial +/− subcutaneous coil(s). Median DFT was 7 J (range 3–31 J); 19/20 patients had DFT ≤15 J and all patients <25 kg had DFT ≤9 J (n = 6). There was no difference in DFT between patients with transvenous versus pericardial +/− subcutaneous coils (median 7 J vs 6 J, P = 0.59). No patient with normal atrioventricular conduction prior to defibrillation required postshock pacing (n = 16). There were no adverse events.Conclusions:These data suggest that many pediatric ICD patients have low DFTs and adequate postshock escape rhythm. This may help determine appropriate parameters for future design of pediatric‐specific ICDs. (PACE 2012;35:1487–1493)