부산대학교 도서관

Background: Inappropriate implantable cardioverter-defibrillator (ICD) shocks are a common and significant problem in pediatric patients and patients with congenital heart disease (CHD).Objective: The purpose of this study was to evaluate the effect of programming high detection rates and long detection duration on inappropriate shocks in this population.Methods: We performed a retrospective review of all patients with ICDs at a single pediatric center. Inappropriate shocks were defined as a shock for any rhythm except ventricular tachycardia or fibrillation.Results: A total of 144 patients were included, 63 (44%) with CHD. At implant, mean age and weight were 17 ± 10 years and 57 ± 23 kg. ICDs were single chamber in 35 (24%), dual chamber in 97 (67%), and biventricular in 12 (8%). The mean follow-up duration was 42 ± 39 months. Appropriate shocks occurred in 29 (20.1%) and inappropriate shocks in 14 (9.7%). Causes of inappropriate shocks were supraventricular tachycardia (n = 6), lead malfunction (n = 4), sinus tachycardia (n = 3), and T-wave oversensing (n = 1). The mean ventricular fibrillation detection rate was 222 ± 15 beats/min, and the detection duration was 18 ± 12 beats. Patients with shocks programmed in the ventricular tachycardia zone were more likely to receive an inappropriate shock (P = .03). There were no associations between inappropriate shocks and age or weight at implant, presence of CHD, dual-chamber vs single-chamber device, history of supraventricular tachycardia, or antiarrhythmic use. There were no adverse events as a result of programming.Conclusion: Programming high detection rates and long detection duration resulted in a low rate of inappropriate shocks without associated adverse events in this large cohort of pediatric and CHD patients with ICDs.