Implantable Cardioverter Defibrillator Programming Characteristics, Shocked Rhythms, and Survival Among Patients Under Thirty Years of Age. (28th July 2016)

• Record Type: Journal Article
• Authors: CHANG, PHILIP M.; POWELL, BRIAN D.; JONES, PAUL W.; CARTER, NATHAN; HAYES, DAVID L.; SAXON, LESLIE A.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 27:Number 10(2016)
• Page Start: 1183
• Page End: 1190
• Publication Date: 2016-07-28
• Subjects: adult congenital heart disease -- implantable cardioverter‐defibrillator -- pediatrics -- remote monitoring; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.13038
• Languages: English
• ISSNs: 1045-3873

Abstract

ICD Characteristics and Survival in Young Patients: Introduction: Indications for implantable cardioverter defibrillators (ICDs) in young patients have expanded and differ from those in older adults. We sought to provide descriptive characteristics and data regarding ICD therapy and outcomes among younger and older ICD recipients. Methods and Results: Demographics, device type and programming, remotely transmitted data, shock events, and survival were compared among younger (≤30 years) and older (>30 years) cohorts with ICDs from a single manufacturer followed on a remote network. The younger cohort included 904 patients (1.6% of all implants). This group had more females (46% vs. 25%; P < 0.01), single‐coil leads (21% vs. 4%; P < 0.01), and single‐chamber devices (46% vs. 34%; P < 0.01). Shock incidence was higher (40% younger vs. 32% older at 4 years; P < 0.01) and survival was better over comparable follow‐up (88% vs. 72%; P < 0.01). Remote monitoring was associated with improved survival in both groups (93% vs. 86% ≤ 30 years, P < 0.01; 73% vs. 66% > 30 years, P < 0.01). Shock for polymorphic ventricular tachycardia/fibrillation (VT/VF) was more frequent in younger patients (12% vs. 5%; P < 0.01); 39% of all shocks were inappropriate. A 10‐fold increased risk of mortality was seen among young patients with shocks for atrial fibrillation/flutter (AF/AFL). Conclusions: Differences in survival, shock incidence, and prognostic significance of VT/VF and AF/AFL exist between younger and older ICD recipients. These suggest distinct differences in myocardial substrates and diseases that ultimately impact ICD management.