In a cohort of 49 pediatric patients, appropriate ICD shocks occurred in 27% of the secondary prevention group, with a 6% overall mortality rate over 207 patient-years of follow-up.
What are the indications, complications, and outcomes of implantable cardioverter-defibrillator therapy in pediatric patients?
Pediatric ICD therapy provides effective secondary prevention but is associated with substantial device-related morbidity (17% major complications) and inappropriate shocks (22%), highlighting the potential value of less invasive S-ICD systems.
ABSTRACT Aims Implantable cardioverter‐defibrillator (ICD) therapy in children, particularly for primary prevention, remains under investigation, with limited data from less affluent European countries. With increasing use of fully subcutaneous (S‐ICD) and extravascular (EV‐ICD) systems, we analyzed epidemiology, indications, complications, and outcomes in pediatric ICD recipients at our tertiary center. Methods This retrospective, population‐based, nationwide, single‐center study consecutively analyzed medical records from 2012 to 2025. Patients aged 0–18 years who underwent ICD implantation were included. Kaplan–Meier analyses were performed for shock‐free and mortality endpoints. Results Forty‐nine patients were included, corresponding to an estimated national incidence of approximately one ICD implantation per 22 000 live births. ICDs were predominantly implanted for secondary prevention (80%). Long QT syndrome (32%) and hypertrophic cardiomyopathy (22%) were the most frequent diagnoses. During 207 patient‐years of follow‐up (median follow‐up 4 years), appropriate ICD shocks occurred in 27% of patients exclusively in the secondary prevention group. No appropriate therapies occurred in the primary prevention group despite higher overall mortality. Inappropriate shocks occurred in 22% of patients. Device‐related major complications affected 17% of implanted systems. Median transvenous ICD battery longevity was 6.5 years. Overall mortality was 6%, all related to underlying structural heart disease, with no ICD‐related deaths. S‐ICDs demonstrated a favorable acute and mid‐term safety profile in patients without pacing requirements. Conclusions Pediatric ICD therapy is limited by substantial device‐related morbidity and imperfect risk stratification for primary prevention. The emerging S‐ICD and EV‐ICD systems represent promising, less invasive alternatives for selected pediatric patients.
Bjeloševič et al. (2026) studied this question. In a cohort of 49 pediatric patients, appropriate ICD shocks occurred in 27% of the secondary prevention group, with a 6% overall mortality rate over 207 patient-years of follow-up.