Implantable Cardioverter-Defibrillators in Children: Innovation to Design a Pediatric Implantable Cardioverter-Defibrillator

Although the implantable cardioverter-defibrillator (ICD) is now established as safe and effective for prevention of sudden cardiac death (SCD) in children, pediatrics accounts for less than 1% of market share, inhibiting corporate financial incentive for development of a pediatricspecific device. Over the past two decades since the ICD became clinically available, progressive downsizing of devices and leads has allowed for their use in children. However, the smallest of children and those with particular forms of congenital heart disease (CHD) often require customized implant techniques. Children have different implant indications, implant techniques, programming issues, psychosocial impact, and follow-up care considerations. Compared with the typical adult ICD patient, most pediatric ICD patients outlive their device by decades. This necessitates proper advance planning to maximize device and lead longevity, vascular patency, and other chronic management issues. This paper will briefly review the specific indications and implantation issues unique to pediatrics and will suggest future innovations to consider for developing a pediatric defibrillator.