THE AUTOMATIC IMPLANTABLE CARDIOVERTER-DE FIBRILLATOR FOR PREVENTION OF SUDDEN CARDIAC DEATH IN CHILDREN AND ADOLESCENTS

Little experience exists with the automatic implantable cardioverter-d efibrillator in the pediatric population. Since 1990, an automatic imp lantable cardioverter defibrillator was implanted in four young patien ts (mean age 15.8 years, mean body weight 53.3 kg) with life-threateni ng ventricular tachyarrhythmias at our institution. In three patients, a cardiac anomaly was evident (dilated cardiomyopathy, status post Ra stelli operation for complex transposition of the great arteries, stat us post atrial switch for transposition of the great arteries), the la st patient had a normal cardiac anatomy. Indications for implantation were resuscitation from documented hypotensive ventricular tachycardia in one patient and recurrent syncope of suspected cardiac origin in t he remaining three patients. At preimplantation electrophysiological s tudy, all four patients had inducible ventricular tachycardia and/or v entricular fibrillation. At implantation of the cardioverter defibrill ator in the operating theatre, the ventricular tachyarrhythmias were a gain induced and terminated reliably by the device. After a mean follo w-up of 13 months, three of the four patients had appropriate discharg es without syncope or resuscitation. The automatic implantable cardiov erter-defibrillator appears to be a feasible and effective therapy als o in pediatric patients for prevention of sudden cardiac death due to ventricular tachyarrhythmias.