Evaluation of safety and efficacy of pacemaker and defibrillator implantation by axillary incision in pediatric patients.
We successfully implanted 11 pacemakers, 6 defibrillators, and 1 biventricular pacemaker in 18 pediatric patients (15 female; 4 to 15 years, average age: 9) using the retropectoral transvenous approach with a hidden axillary incision. The average follow-up period was 24 months (range 49 months). Eight patients had congenital structural heart conditions (d-transposition of great arteries S/P Mustard operation, d-transposition of great arteries S/P arterial switch operation, truncus arteriosus, right ventricular diverticula, ventricular septal defect, hypertrophic cardiomyopathy). Four patients had acquired heart conditions (dilated cardiomyopathy, myocarditis). Excellent sensing and pacing thresholds were achieved in all attempted implantations. There was no pneumothorax. There was one lead dislodgement. One lead fracture distant from the subclavian vein occurred 4 months after implantation. Implantation of pacemakers and defibrillators via axillary incisions can be safe and effective in pediatric patients. This approach avoids skin erosion when implanting large devices such as defibrillators or biventricular devices in small patients with limited muscle mass while achieving superior aesthetic results. The axillary or extrathoracic venous entry site avoids subclavian crush syndrome.
Lee
Joselyn C R
JC
Division of Pediatric Cardiology, VA Greater Los Angeles Healthcare System, University of California at Los Angeles, Los Angeles, California, USA. joselyn-lee@stanfordalumni.org
Shannon
Kevin
K
Boyle
Noel G
NG
Klitzner
Thomas S
TS
Bersohn
Malcolm M
MM
D000293:Adolescent; D001367:Axillary Vein / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000601:surgery; D010138:Pacemaker, Artificial; D010369:Pectoralis Muscles / Q000601:surgery; D019919:Prosthesis Implantation / Q000379:methods*; D012449:Safety; D013350:Subclavian Vein / Q000601:surgery; D016896:Treatment Outcome