Pediatric ICD utilization in the United States from 1997 to 2006

BACKGROUND Indications for implantable cardioverter-defibrillator (ICD) implantation in children have expanded, yet pediatric population-based data on ICD implantation are lacking. OBJECTIVE We characterized trends in pediatric ICD use in the United States from 1997 to 2006. METHODS We examined national hospital administrative data from the 1997, 2000, 2003, and 2006 Kids' Inpatient Database (KID) for new ICD implants in patients younger than 18 years of age and characterized patients, hospitals, and hospitalization-related outcomes. RESULTS The number of pediatric ICD implants per year increased 3-fold (from 130 in 1997 to 396 in 2006, P = .003). Implants with a concomitant diagnosis of life-threatening arrhythmia decreased from 77% to 45% (P = .001). The average age decreased from 13.6 to 12.2 years (P = .01), and the percentage of patients younger than 5 years of age tended to increase (up to 10%, P = .09). In 2006, the number of implants per center ranged from 1 to 24 (median 3). Over time, the complication rate tended to decrease (from 16 to 10%, P = .07). Complication rate was not related to a diagnosis of congenital heart disease, age, or implant volume. CONCLUSION ICD use increased dramatically in children from 1997 to 2006, although implantation declined in patients with a concomitant diagnosis of life-threatening arrhythmia (those likely to undergo implantation for secondary prevention). The complication rate tended to decrease overall. Each center implants relatively few ICDs per year, which may have implications for competency and training.