Midterm Efficacy of SubcutAneous Implantable CardioVErter ‐Defibrillator in ≤ 18 Year‐Old CHILDREN ( SAVE CHILDREN ‐ II Registry)

Background The subcutaneous implantable cardioverter‐defibrillator (S‐ICD) avoids transvenous leads and is a promising option for sudden cardiac death (SCD) prevention in pediatric patients. However, mid‐term outcomes and post‐shock management strategies remain insufficiently characterized. Methods This multicenter, retrospective observational study included pediatric patients (≤ 18 years) who underwent S‐ICD implantation between February 2016 and July 2021. Clinical characteristics, pre‐implant screening, procedural details, device‐related events, and follow‐up data were analyzed. The incidence and management of appropriate and inappropriate therapies and subsequent recurrence were evaluated. Results Ninety‐six patients (median age 14.5 years) were enrolled and followed for a median of 70 months (29–75.0 months). Sensing vector suitability remained stable despite somatic growth. Appropriate shocks occurred in 32 patients (33.7%), while inappropriate shocks occurred in 27 (28.4%). After appropriate therapy, intensified pharmacological treatment and catheter ablation prevented recurrent device therapy in 45.5% and 50.0% of cases, respectively, although device shock occurred in 50.9% despite intervention. Following inappropriate therapy, device reprogramming and lifestyle guidance prevented recurrence in 71.4% of patients (15/21). Device‐related infection was rare (2 cases), and no lead fractures were observed. Conclusions S‐ICD therapy demonstrated favorable mid‐term safety and efficacy in pediatric patients, with durable sensing performance and a low incidence of device‐related infection. Although inappropriate shocks were not uncommon, appropriate post‐shock management effectively reduced recurrence, supporting S‐ICD as a viable option for selected pediatric patients without pacing requirements.