CONGRESS ABSTRACT

BACKGROUND Despite sudden cardiac death (SCD) is a rare phenomenon in pediatric age, the use of the implantable defibrillator (ICD) is progressively increasing in consideration of its life-saving role both in primary and in secondary prevention. The aim of this study is to assess the long-term follow-up of pediatric patients undergoing ICD implantation at our tertiary center. METHODS The retrospective study includes 70 patients with a mean age 14 years (range 2.8-18) underwent ICD implantation between 2010 and 2025. We used three different implantation technique (endocavitary, subcutaneous and hybrid technique) depending on heart disease, size of the patient and the cardiac anatomy. All device has been programmed in a personalized way based on age and cardiac pathology. During follow up appropriate shocks, acute and chronic complications, in particular inappropriate shocks, were evaluated. RESULTS Of the 70 implanted patients, 57% had cardiomyopathy, 24% had a primary electrical disease, and 19% had congenital heart disease. The implants were performed in 55% of cases for primary prevention and 45% for secondary prevention. CHD and CM are mostly implanted in primary prevention. The study shows that 26 patients (37%) were correctly treated by the device with appropriate shock or ATP with an average Shock/patient of 2.6. Of the 26 treated patients, 12 (46.2%) were implanted as primary prevention of which one third (33.3%) were HCM. Seventeen (24.6%) patients underwent heart transplantation listing and 65% had appropriate discharges with an average shocks/patient of 2.2. There were no acute complications related to ICD implantation. During follow-up (mean follow-up time 9±5 years; range 1-15 yeas), two patients (2.8%) experienced epicardial lead rupture in hybrid ICD implants without episodes of inappropriate shocks. No endocavitary lead ruptures occurred. Eight (11.6%) subjects experienced inappropriate discharges, seven of which were due to high-rate supraventricular tachycardias and one due to T-wave oversensing. CONCLUSIONS The study confirmed the protective role of the device, in terms of prevention of sudden cardiac death, and its relevance as bridge to heart transplantation in pediatric age. Appropriate device programming significantly reduced inappropriate shocks in our patients. Lead failure was greater in hybrid implants than in traditional ones.