Epicardial ICDs in children were associated with similar rates of late ICD-related complications compared to transvenous ICDs (29.8% vs 23.7%; HR 1.8, 95% CI 0.8-4.0).
Cohort (n=122)
No
Does epicardial ICD compared to transvenous ICD affect the rate of complications and lead dysfunction in children?
In children requiring an ICD, epicardial and transvenous approaches have similar long-term complication and lead dysfunction rates after adjusting for patient characteristics like age and weight.
Hazard Ratio: 1.8 (95% CI 0.8–4)
Absolute Event Rate: 29.8% vs 23.7%
AIMS: The implantable cardioverter defibrillator (ICD) has been increasingly used in children. Both epicardial and transvenous approaches are used, with controversy regarding the best option with no specific recommendations. We aimed to compare outcomes associated with epicardial vs. transvenous ICDs in children. METHODS AND RESULTS: Data were analysed from a retrospective study including all patients <18-year-old implanted with an ICD in a tertiary centre from 2003 to 2021. Outcomes were compared between epicardial and transvenous ICDs. A total of 122 children with an ICD (mean age 11.5 ± 3.8 years, 57.4% males) were enrolled, with 84 (64.1%) epicardial ICDs and 38 (29.0%) transvenous ICDs. Early (<30 days) ICD-related complications were reported in 17 (20.2%) patients with an epicardial ICD vs. 0 (0.0%) with a transvenous ICD (P = 0.002). Over a mean follow-up of 4.8 ± 4.0 years, 25 (29.8%) patients with an epicardial ICD and 9 (23.7%) patients with a transvenous ICD experienced at least one late ICD-related complication hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.8-4.0. Implantable cardioverter defibrillator lead dysfunction occurred in 19 (22.6%) patients with an epicardial ICD vs. 3 (7.9%) with a transvenous ICD (HR 5.7, 95% CI 1.3-24.5) and was associated with a higher incidence of ICD-related reintervention (HR 3.0, 95% CI 1.3-7.0). After considering potential confounders, especially age and weight at implantation, this association was no longer significant (P = 0.112). The freedom from ICD lead dysfunction was greater in patients with pleural coils than in those with epicardial coils (HR 0.38, 95% CI 0.15-0.96). CONCLUSION: In children, after a consideration of patient characteristics at implantation, the burden of complications and ICD lead dysfunction appears to be similar in patients with epicardial and transvenous devices. Pleural coils seem to be associated with better outcomes than epicardial coils in this population. CLINICAL TRIAL REGISTRATION: NCT05349162.
Bos et al. (Fri,) conducted a cohort in Children requiring an implantable cardioverter defibrillator (n=122). Epicardial ICD vs. Transvenous ICD was evaluated on Late ICD-related complication (HR 1.8, 95% CI 0.8-4.0). Epicardial ICDs in children were associated with similar rates of late ICD-related complications compared to transvenous ICDs (29.8% vs 23.7%; HR 1.8, 95% CI 0.8-4.0).
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