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Implantable cardioverter-defibrillator implantation for primary and secondary prevention: indications and outcomes

Published online by Cambridge University Press:  13 January 2017

Justin M. Pick  and
Anjan S. Batra
Justin M. Pick
Affiliation:
Children’s Hospital of Orange County, University of California Irvine, Irvine, California, United States of America
Anjan S. Batra*
Affiliation:
Children’s Hospital of Orange County, University of California Irvine, Irvine, California, United States of America
*
Correspondence to: A. S. Batra, MD, 1140 W. La Veta Avenue, Suite 750; Orange, CA 92868, United States of America. Tel: +714 581 4401; Fax: 714-581-4420; E-mail: abatra@uci.edu
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Abstract

Implantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.

Keywords

Implantable cardioverter-defibrillatorprimary preventionsecondary preventionsudden cardiac death
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S126 - S131
Copyright
© Cambridge University Press 2017 

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