Current Trends in Use of Implantable Cardioverter Defibrillators and Cardiac Resynchronization Therapy With a Pacemaker or Defibrillator in Japanese Pediatric Patients - Results From a Nationwide Questionnaire Survey

Background: In Japan, the use of implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy with a biventricular pacemaker (CRTP) and CRT with a defibrillator (CRTD) in children has not been studied statistically, and dual-chamber (DDD) pacemakers are still used for pediatric CRT because of current government regulations. Methods and Results: Data were obtained from 15 children's and 74 general hospitals through a questionnaire survey regarding the aforementioned therapies performed before 2012 in Japanese children (<16 years old). ICD, CRT with DDD, CRTP and CRTD were used in 64 (42%), 47 (31%), 34 (22%) and 7 (5%), respectively, of all cases reported (n=152). Among all CRTP and CRT-DDD cases (n=81), the use of DDD accounted for 41% in general hospitals vs. 89% in children's hospitals, and CRT-DDD and CRTP were effective in 67 cases (83%). Of 64 ICD cases, appropriate shocks were experienced in 28 cases (44%), and inappropriate shocks in 19 cases (29%). Additionally, data from the Japan Arrhythmia Device Industry Association obtained for overall device usage analysis revealed that CRTP was more commonly used in children than in adults. Conclusions: There is an increasing need for pediatric device therapy, especially CRTP. However, many children's hospitals were still using DDD pacemakers in 2012. Although the demand for device therapy in children may be small, it is indispensable in pediatric cardiology.