Implantable cardioverter-defibrillators (ICDs) may save the lives of some children with hypertrophic cardiomyopathy (HCM) but there are problems that remain to be solved. At three London hospitals 160 children with HCM were assessed between 1993 and February 2006 and 22 children aged 7-16 years had ICD implantation into subpectoral pockets using transvenous lead systems (

) . Sixteen patients received dual chamber devices. Seventeen devices were implanted for primary prevention and five for secondary prevention of potentially fatal arrhythmias. Median follow up was 1.7 years. Four patients received 15 appropriate shocks (for ventricular tachycardia or fibrillation) and on each occasion a single shock was successful. Four patients had seven inappropriate shocks caused by sinus tachycardia or supraventricular tachycardia (three patients) or lead fracture (one patient). One patient developed acute bacterial endocarditis and the youngest child suffered from anxiety and depression attributed to ICD discharges. It is concluded that ICDs are effective in selected children with HCM. Outstanding issues include prevention of inappropriate discharges, provision of psychological support, and prevention of infection.

Despite immunoglobulin treatment about 5% of children with Kawasaki disease develop coronary aneurysms. The role of early treatment with corticosteroid is uncertain. Now a trial at eight centres in the USA and Canada (

; see …