Decrease of implantable cardioverter-defibrillator shock therapy in children: correlation with ICD programming and remote monitoring

BackgroundImplantable cardioverter defibrillator (ICD) therapy is effective in preventing sudden cardiac death in children. Unnecessary shocks should be avoided. ICD programming strategies and remote monitoring effective in preventing ICD shock therapy in adults have been applied in children ObjectivesTo investigate the effect of ICD programming and remote monitoring on th incidence of ICD shock therapy in children. MethodsRetrospective multi-center study, including children with transvenous or epicardial ICD implantation. During follow-up ICD-shocks, programming variables and use of remote monitoring were collected. ResultsOne-hundred-sixteen children were included, median age 13.4 years (min-max 0.3-18), median follow-up 5.2 years (IQR 3.7-6.6). Fifty-three with an ICD implanted before 2010 and 63 after 2010. The total, appropriate and inappropriate annual shock rate decreased from 10.5% to 8% (difference in mean cumulative function (MCF) P=0.008), 7.8% to 5.8% (MCF P=0.036) and 4.3% to 2.6% (MCF P=0.28) respectively, without increase in cardiac related death. The VF zone was programmed higher ([≥]210 bpm) in patients before 2010 compared to after 2010 (76% vs 90%; P=0.142), in patients with versus without shocks (79% vs 89%; P=0.243) and at time of appropriate versus inappropriate shocks (86% vs 79%; P=0.0016). Remote monitoring was associated with a decrease of total shocks (MCF P=0.013) and appropriate shocks (MCF P=0.052). ConclusionsThe incidence of ICD shocks has significantly decreased in children with implantation after 2010. A higher programmed VF-zone and application of remote monitoring are correlated to this decrease and therefore justify its use in strategies to prevent unnecessary shocks in children.