An International Multicenter Cohort Study on Implantable Cardioverter Defibrillators for the Treatment of Symptomatic Children with Catecholaminergic Polymorphic Ventricular Tachycardia

Avani Lamba, Thomas M Roston, Puck J Peltenburg, Dania Kallas, Sonia Franciosi, Krystien V V Lieve, Prince J Kannankeril, Minoru Horie, Seiko Ohno, Ramon Brugada, Takeshi Aiba, Peter Fischbach, Linda Knight, Jan Till, Sit-Yee Kwok, Vincent Probst, David Backhoff, Martin J LaPage, Anjan S Batra, Fabrizio DragoKristina Haugaa, Andrew D Krahn, Tomas Robyns, Heikki Swan, Terezia Tavacova, Joseph Atallah, Martin Borggrefe, Boris Rudic, Georgia Sarquella-Brugada, Ehud Chorin, Allison Hill, Janneke Kammeraad, Anna Kamp, Ian Law, James Perry, Jason D Roberts, Svjetlana Tisma-Dupanovic, Christopher Semsarian, Jonathan R Skinner, Jacob Tfelt-Hansen, Isabelle Denjoy, Antoine Leenhardt, Peter J Schwartz, Michael J Ackerman, Arthur A M Wilde, Christian van der Werf, Shubhayan Sanatani

Abstract

BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) may cause sudden cardiac death (SCD) despite medical therapy. Therefore, implantable cardioverter-defibrillators (ICDs) are commonly advised. However, there are limited data on the outcomes of ICD use in children.

OBJECTIVE: The purpose of this study was to compare the risk of arrhythmic events in pediatric patients with CPVT with and without ICD.

METHODS: We compared the risk of SCD in patients with RYR2 (ryanodine receptor 2) variants and phenotype-positive symptomatic patients with CPVT with and without ICD who were younger than 19 years and had no history of sudden cardiac arrest at phenotype diagnosis. The primary outcome was SCD; secondary outcomes were composite end points of SCD, sudden cardiac arrest, or appropriate ICD shocks with or without arrhythmic syncope.

RESULTS: The study included 235 patients, 73 with ICD (31.1%) and 162 without ICD (68.9%). Over a median follow-up of 8.0 years (interquartile range 4.3-13.4 years), SCD occurred in 7 patients (3.0%), of whom 4 (57.1%) were noncompliant with medications and none had an ICD. Patients with ICD had a higher risk of both secondary composite outcomes (without syncope: hazard ratio 5.85; 95% confidence interval 3.40-10.09; P < .0001; with syncope: hazard ratio 2.55; 95% confidence interval 1.50-4.34; P = .0005). Thirty-one patients with ICD (42.5%) experienced appropriate shocks, 18 (24.7%) inappropriate shocks, and 21 (28.8%) device-related complications.

CONCLUSION: SCD events occurred only in the no ICD group and in those not on optimal medical therapy. Patients with ICD had a high risk of appropriate and inappropriate shocks, which may be reduced with appropriate device programming. Severe ICD complications were common, and risks vs benefits of ICDs need to be considered.

OriginalsprogEngelsk
TidsskriftHeart Rhythm
ISSN1547-5271
DOI
StatusE-pub ahead of print - 6 apr. 2024

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