AIMS: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) are effective in patients who require protection from sudden cardiac death while avoiding the long-term risks associated with transvenous leads. However, data on their real-world performance in paediatric and young patients remain limited. This study aims to evaluate the safety and efficacy of S-ICDs in a large, multicentre cohort of paediatric and young patients across Europe, with a focus on contemporary implantation practices and clinical outcomes. METHODS AND RESULTS: This is an international, multicentre, observational, retrospective registry on S-ICD outcome in paediatric and young adult patients with congenital heart defects (CHD), cardiomyopathies, channelopathies, and idiopathic ventricular fibrillation (IVF). Data were collected on implantation techniques, acute and long-term outcomes, including defibrillation efficacy, inappropriate (IAS) and appropriate shocks, and complications. Follow-up data were analysed to assess device performance and safety. A total of 223 patients (mean age: 15 ± 3 years; 59% male, 53% cardiomyopathies, 18% channelopathies, 15% IVF, 14% CHD) were included. Most patients underwent implantation using an intermuscular (65%) and two-incision technique (88%). Acute defibrillation success was 100%, and no intraoperative complications occurred. The median follow-up was 28 (IQR: 12-55) months. Appropriate shocks were delivered in 41 (18%) patients (26% rate at 5 years). The first shock was effective in 92% of discrete episodes. The IAS and the complication rates were 20% and 5% at 5 years. Older age, intermuscular pocket, and two-incision technique were associated with fewer complications. CONCLUSION: This multicentre S-ICD European registry in paediatric and young patients demonstrated favourable outcomes, low IAS, and complication rates.

Cardiac Rhythm Management Boston Scientific Milan Italy

Children's Heart Centre 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Arrhythmias and Cardiac Pacing Paediatric Cardiac Centre National Institute of Cardiovascular Diseases Bratislava Slovakia

Department of Cardiology Leiden University Medical Center Leiden The Netherlands

Department of Paediatric Cardiology Amsterdam University Medical Centers Amsterdam The Netherlands

Department of Paediatric Cardiology and Congenital Heart Defects Department of Cardiology and Electrotherapy Faculty of Medicine Medical University of Gdansk Gdansk Poland

Department of Paediatric Cardiology Heart Centre Leipzig University of Leipzig Leipzig Germany

Department of Paediatric Cardiology Hôpital Necker Enfants Malades Université Paris Cité Paris France

Department of Paediatrics Antwerp University Hospital Faculty of Medicine and Health Sciences University of Antwerp Antwerp Belgium

Department of Pediatric Cardiology and General Pediatrics Medical University of Warsaw Warsaw Poland

Gottsegen National Cardiovascular Center Hungarian Pediatric Heart Center Budapest Hungary

Hopital Marie Lannelongue M3C GHPSJ Université Paris Descartes Paris France

Paediatric Cardiology and Cardiac Arrhythmia Syncope Unit Cardiology and Arrhythmia Unit and Syncope Unit Bambino Gesù Children's Hospital IRCCS Via Torre di Palidoro 1 00050 Palidoro Fiumicino Rome Italy

Pediatric Cardiology Vall d'Hebron Research Institute Barcelona Spain

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