Implantable cardioverter defibrillator-Indications in childhood

Implantation of an implantable cardioverter defibrillator (ICD) is indicated to prevent sudden cardiac death due to life-threatening ventricular tachycardia or ventricular fibrillation. There is an indication for ICD implantation in childhood as secondary prevention after resuscitation due to persistent ventricular tachyarrhythmia in almost every case. The indication for ICD implantation as primary prevention depends on the specific risk assessment of the disease in combination with risk factors of the patient and risk of the ICD treatment itself and remains in many cases a case by case decision in consultation with the family. The most important diseases in childhood associated with an increased risk of sudden cardiac death are cardiac channelopathies (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome), cardiomyopathies (arrhythmogenic ventricular cardiomyopathy, hypertrophic cardiomyopathy, nonischemic dilated cardiomyopathy, left ventricular non-compaction cardiomyopathy and arrhythmic mitral valve syndrome) as well as congenital heart defects. Transvenous, non-transvenous (extracardiac), and subcutaneous ICD systems are available. The choice depends on the individual's age, underlying disease, anatomic conditions, and need for pacing, antitachycardia pacing or resynchronization therapy. The complication rate of ICD treatment is higher in children than in adults, particularly due to inappropriate shock delivery and lead malfunction.