Use of implantable cardioverter-defibrillator in children supported with ventricular assist device: An analysis of data from teh EUROMACS registry

Background: Data on the use and outcome of children on ventricular assist device (VAD) support provided with an implantable cardioverter--defibrillator (ICD) remains poor. Methods: A retrospective analysis of the EUROMACS database on children supported with VAD < 19 years of age from January 1, 2009 to April 1, 2020. Patients with missing data on status of ICD, missing baseline and/or follow up information were excluded. The primary independent variable of interest was the concomitant presence or absence of an ICD at the time of VAD placement. Kaplan--Meier survival analysis was performed to evaluate survival differences between children on VAD with and without an ICD. Results: Out of 303 patients provided with a VAD, 7% (7 female, 15 male) had an ICD implanted and formed the study group. Median age was 14 years, median weight was 43.5 kg, and median BSA was 1.39. Median Intermacs stage was 2 (range: 1-7). Seventeen patients (77%) were transplanted, 4 (18%) died while on support, and 1 (5%) was weaned from device after myocardial recovery. Median time on support was 68 days compared to 361 days in the control group (p: 0.01). Three patients underwent device exchange due to thrombus formation in the pump. There was no difference in survival between groups (p = 0.342). Conclusion: The presence of ICD in pediatric patients supported with a VAD is low (7%). Children on VAD support provided with an ICD do not have a survival benefit compared to children without an ICD.