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Clinical Trial
. 2023 Mar 30;25(3):961-968.
doi: 10.1093/europace/euad015.

Epicardial vs. transvenous implantable cardioverter defibrillators in children

Pierre Antoine Le Bos  1 , Margaux Pontailler  2 , Alice Maltret  1 , Diala Kraiche  1 , Regis Gaudin  2 , Claudio Barbanti  3 , Eloi Marijon  4   5 , Olivier Raisky  2   4 , Damien Bonnet  1   4   6 , Victor Waldmann  1   4   5   6
Affiliations
Clinical Trial

Epicardial vs. transvenous implantable cardioverter defibrillators in children

Pierre Antoine Le Bos et al. Europace. .

Abstract

Aims: The implantable cardioverter defibrillator (ICD) has been increasingly used in children. Both epicardial and transvenous approaches are used, with controversy regarding the best option with no specific recommendations. We aimed to compare outcomes associated with epicardial vs. transvenous ICDs in children.

Methods and results: Data were analysed from a retrospective study including all patients <18-year-old implanted with an ICD in a tertiary centre from 2003 to 2021. Outcomes were compared between epicardial and transvenous ICDs. A total of 122 children with an ICD (mean age 11.5 ± 3.8 years, 57.4% males) were enrolled, with 84 (64.1%) epicardial ICDs and 38 (29.0%) transvenous ICDs. Early (<30 days) ICD-related complications were reported in 17 (20.2%) patients with an epicardial ICD vs. 0 (0.0%) with a transvenous ICD (P = 0.002). Over a mean follow-up of 4.8 ± 4.0 years, 25 (29.8%) patients with an epicardial ICD and 9 (23.7%) patients with a transvenous ICD experienced at least one late ICD-related complication [hazard ratio (HR) 1.8, 95% confidence interval (CI) 0.8-4.0]. Implantable cardioverter defibrillator lead dysfunction occurred in 19 (22.6%) patients with an epicardial ICD vs. 3 (7.9%) with a transvenous ICD (HR 5.7, 95% CI 1.3-24.5) and was associated with a higher incidence of ICD-related reintervention (HR 3.0, 95% CI 1.3-7.0). After considering potential confounders, especially age and weight at implantation, this association was no longer significant (P = 0.112). The freedom from ICD lead dysfunction was greater in patients with pleural coils than in those with epicardial coils (HR 0.38, 95% CI 0.15-0.96).

Conclusion: In children, after a consideration of patient characteristics at implantation, the burden of complications and ICD lead dysfunction appears to be similar in patients with epicardial and transvenous devices. Pleural coils seem to be associated with better outcomes than epicardial coils in this population.

Clinical trial registration: NCT05349162.

Keywords: Congenital heart disease; Implantable cardioverter defibrillator; Paediatric; Sudden death; Ventricular arrhythmia.

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Conflict of interest statement

Conflict of interest: Victor Waldmann is consultant for Abbott, Medtronic, and Withings.

Figures

Figure 1
Figure 1
Examples of epicardial ICDs. Epicardial ICDs with a defibrillation coil inserted in the pleural position (A) and in the epicardial position on the anterior wall of the right ventricle (B). ICD, implantable cardioverter defibrillator.
Figure 2
Figure 2
Age of patients at ICD implantation. ICD, implantable cardioverter defibrillator.
Figure 3
Figure 3
Underlying heart diseases in patients with epicardial and transvenous ICD. ARVD, arrhythmogenic right ventricular dysplasia; CHD, congenital heart disease; ICD, implantable cardioverter defibrillator; CPVT, catecholaminergic polymorphic ventricular tachycardia; LQTS, long QT syndrome; VF, ventricular fibrillation.
Figure 4
Figure 4
Kaplan–Meier curves of survival without any late ICD-related complication (A), ICD lead dysfunction (B), and reintervention (C). CI, confidence interval; HR, hazard ratio; ICD, implantable cardioverter defibrillator.
Figure 5
Figure 5
Kaplan–Meier curves of survival without ICD lead dysfunction in patients with an epicardial ICD. CI, confidence interval; HR, hazard ratio; ICD, implantable cardioverter defibrillator.
See this image and copyright information in PMC

References

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