ICD indications in children with structural heart disease

Late arrhythmias after cardiac surgery is common and associated with ventricular dysfunction. TOF, D-TGA (after atrial switch), Congenital AS and palliated univentricular heart are the important risk fators for post operative cardiac arrhythmias and sudden cardiac death.
QRS width more than 180 msec is a risk factor for SCD after TOF repair. Positive predictive value of inducible VT was only 55% while negative predictive value was 96%. Combination of left ventricular dysfunction and QRS width more than 180 msec had a high predictive value.
Following atrial switch for D-TGA, those with arrhythmic events were at higher risk for SCD. EP study did not predict which patient is likely to get an appropriate shock when ICDs were implanted for primary prevention.
Death rate is higher in patients with post repair gradients in co-arctation of aorta. Any significant gradient after repair has to be aggressively addressed to reduce the late mortality.