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ICD – Indikationen im Kindesalter

Implantable cardioverter defibrillator—Indications in childhood

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Die Implantation eines implantierbaren Kardioverter-Defibrillators (ICD) erfolgt zur Prävention des plötzlichen Herztodes bei lebensbedrohlichen ventrikulären Tachyarrhythmien – ventrikulären Tachykardien oder Kammerflimmern. Eine Indikation zur ICD-Implantation im Kindesalter ist als Sekundärprävention, also nach einer Reanimation aufgrund einer anhaltenden ventrikulären Tachyarrhythmie, fast in jedem Fall gegeben. Bei der Indikation zur ICD-Implantation als Primärprävention muss zwischen der Risikobewertung der Erkrankung in Verbindung mit den Risikofaktoren des Patienten und den Risiken der ICD-Therapie abgewogen werden. Die Indikationsstellung bleibt in vielen Fällen eine Einzelfallentscheidung in Abstimmung mit der Familie. Die Erkrankungen im Kindesalter, die mit einem erhöhten Risiko für den plötzlichen Herztod einhergehen, sind genetische Ionenkanalerkrankungen (Long-QT Syndrom, Brugada-Syndrom, katecholaminerge polymorphe ventrikuläre Tachykardie und Short-QT-Syndrom), Kardiomyopathien (arrhythmogene Kardiomyopathie, hypertrophe, dilatative und linksventrikuläre Non-Compaction-Kardiomyopathie und das „arrhythmic mitral valve syndrome“) sowie angeborene Herzfehler. Als ICD-Systeme stehen transvenöse, nontransvenöse (extrakardiale) und subkutane Systeme zur Verfügung; die Wahl ist individuell abhängig von dem Alter, von der Grunderkrankung, den anatomischen Gegebenheiten und der Notwendigkeit für Stimulation, antitachykarde Stimulation oder Resynchronisation. Die Komplikationsrate einer ICD-Therapie ist bei Kindern insbesondere durch nichtadäquate Schockabgaben und Sondendysfunktionen höher als bei Erwachsenen.

Abstract

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.

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  1. Universitätsklinik für Pädiatrische Kardiologie, Herzzentrum Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland

    Sophia Klehs, Roman Gebauer, Ingo Dähnert & Christian Paech

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  1. Sophia Klehs
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Correspondence to Sophia Klehs.

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S. Klehs, R. Gebauer, I. Dähnert und C. Paech geben an, dass kein Interessenkonflikt besteht.

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Klehs, S., Gebauer, R., Dähnert, I. et al. ICD – Indikationen im Kindesalter. Z Herz- Thorax- Gefäßchir (2024). https://doi.org/10.1007/s00398-024-00635-4

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