Comparison of complications and shocks in paediatric and young transvenous and subcutaneous implantable cardioverter-defibrillator patients

BackgroundYoung implantable cardioverter-defibrillator (ICD) patients are prone to complications and inappropriate shocks (IAS). The subcutaneous ICD (S-ICD) may avoid lead-related complications. This study aims to describe the incidence and nature of device-related complications in young transvenous ICD (TV-ICD) and S-ICD patients.MethodsSingle-chamber TV-ICD and S-ICD patients up to and including the age of 25years implanted between 2002 and 2015 were retrospectively analysed. Complications were defined as device-related complications requiring surgical intervention. IAS were defined as shocks for anything other than ventricular tachycardia or ventricular fibrillation. Follow-up data were collected 5years post-implantation. Kaplan-Meier estimates for complications at 5-year follow-up were calculated with acorresponding 95% confidence interval.ResultsEighty-one patients (46TV-ICD, 35S-ICD) were included (median age 19.0 (IQR 16.0-23.0) and 16.5 (IQR 13.0-20.2) years respectively). Median follow-up was 60 and 40months respectively. All-cause complication rate was 34% in the TV-ICD group and 25% in the S-ICD group (p=0.64). TV-ICD patients had more lead complications: 23% (10-36%) versus 0% (p=0.02). The rate of infections did not differ between TV-ICD and S-ICD: 2% (0-6%) versus 10% (0-21%) (p=0.15). No systemic infections occurred in the S-ICD patients. The rates of IAS were similar, TV-ICD 22% (9-35%) versus S-ICD 14% (0-30%) (p=0.40), as were those for appropriate shocks: 25% (11-39%) versus 27% (6-48%) (p=0.92).ConclusionThe rates of all-cause complications in this cohort were equal, though the nature of the complications differed. S-ICD patients did not suffer lead failures or systemic infections. An era effect is present between the two groups.