@Article{chd.12585,
AUTHOR = {Stephanie A. Goldstein, Martin J. LaPage, Brynn E. Dechert, Gerald A. Serwer, Sunkyung Yu, Ray E. Lowery, David J. Bradley},
TITLE = {Decreased inappropriate shocks with new generation ICDs in children and patients with congenital heart disease},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {3},
PAGES = {413--418},
URL = {http://www.techscience.com/schd/v13n3/38994},
ISSN = {3071-1738},
ABSTRACT = {<b>Objective:</b> Inappropriate implantable cardioverter defibrillator (ICD) shocks in children and patients
with congenital heart disease (CHD) remain a major complication of device therapy, occurring in as
many as 50% of children with ICDs. New generation devices include algorithms designed to minimize inappropriate shocks. This study aimed to evaluate the effect of new generation ICDs on the
incidence of inappropriate shocks in the pediatric and CHD population.<br/>
<b>Design:</b> Retrospective study of patients with CHD or under age 25 receiving ICDs between 2000
and 2015. New generation ICDs were defined as those with Medtronic “SmartShock” algorithms.<br/>
<b>Results:</b> Two hundred eight devices were implanted in 146 patients. Rates of inappropriate shocks
were similar between diagnoses (P = .71). The rate of inappropriate shock was 15% over median
5.8 years follow-up. In the 36 patients (25%) with new generation ICDs, the rate of inappropriate
shock was 6.3% over 4 years. Comparing old to new generation ICDs, freedom from first inappropriate shock was 90.6% versus 97.1% at 1 year and 80.4% versus 97.1% at 3 years (P = .01). Lead
fracture was associated with having inappropriate shock (hazard ratio 8.5, P < .0001), and there
was no significant difference between the device groups when lead fractures were excluded. Clinical actions were taken in 69% of patients after initial inappropriate shock (such as medication or
program change, system revision, or explant). When an action was taken, subsequent inappropriate
shock was reduced (5.3% vs 49.2% at 1 year; P = .002).<br/>
<b>Conclusions:</b> Pediatric and CHD patients are experiencing reduced inappropriate shocks with new
generation ICD systems, though reduced lead fracture may account for this improvement. Clinical
interventions after inappropriate shock favorably impact the subsequent rate of shocks once an
inappropriate shock occurs.},
DOI = {10.1111/chd.12585}
}