Comparison of ICD implantation approach in children. The IChilDren study

Abstract Background Without dedicated device, implantable cardioverter defibrillators (ICD) implantation in children is a real challenge for physicians. Types of implantation include transvenous, surgical and subcutaneous-ICD approach, but with a lack of reliable data comparing their respective efficacy and safety. Objective We here aim to compare the results of these 3 ICD implantation approaches in children. Methods Consecutive children (<16yo) implanted with an ICD from 2005 to 2021 in 19 french tertiary centers of the French Pediatric and Congenital heart disease network, were retrospectively enrolled in the study. The primary endpoints were the occurrence of lead failure, device infection or inappropriate shock. Results Among 306 patients (mean age 12,6 yo), 34% received a transvenous ICD, 28% a S-ICD and 38% a surgical ICD. During a median follow-up of 4.7 years, endpoints occurred in 24.2% of the total population, more often in the surgical group (p<0.05). After adjustment for age, ICD type and stratification by heart disease, there was an excess risk of lead failure or infection with the surgical ICD compared with the S-ICD (HR 7.54, 95% CI 1.73;32.91, p<0.05). However, when inappropriate shocks were included, the difference was reduced (HR 2.28, 95% CI 1.03;5.04, p>0.05). In addition, no significant difference between transvenous and surgical ICDs was observed in the multivariate analysis. Conclusions We demonstrate a high rate of complication in children implanted with an ICD. The transvenous and surgical approaches are quite similar. S-ICD appears as a promising approach with the lowest serious adverse event rate. Limitation of inappropriate shock remain the main challenge of this technique.Late complications