title: A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.
abstract: BACKGROUND
  In pediatric and congenital heart disease patients, transvenous ICD implantation may be limited secondary to patient size, venous, or cardiac anatomy. Epicardial patches require a thoracotomy, and may lead to a restrictive pericardial process. Because of these issues, we have explored novel ICD configurations.
  
  
  METHODS
  Retrospective review at 10 centers implanting ICDs without a transvenous shocking coil or epicardial patches.
  
  
  RESULTS
  Twenty-two patients underwent implant at a mean age of 8.9 years (range: 0.3-43.5), with a mean weight of 25.5 kg (range: 5.2-70). Diagnoses included complex CHD, intracardiac tumors, cardiomyopathy, idiopathic VT, LV noncompaction, and long QT syndrome. Three configurations were used: subcutaneous array, a transvenous design ICD lead placed on the epicardium, or a transvenous design ICD lead placed subcutaneously. Difficulties were found at implant in 8 patients: 4 had difficulty inducing VT/VF, and 4 had high DFTs. Over a mean follow-up of 2.2 years (range: 0.2-10.5), 7 patients had appropriate shocks. Inappropriate shocks occurred in 4 patients. System revisions were required in 7 patients: 2 generator changes (in 1 patient), 3 pace-sense lead replacement, 1 additional subcutaneous coil placement due to increased DFT, 1 upgrade to a transvenous system, and 1 revision to epicardial patch system.
  
  
  CONCLUSIONS
  ICD implantation can be performed without epicardial patches or transvenous high-energy leads in this population, using individualized techniques. This will allow ICD use in patients who have intracardiac shunting or are deemed too small for transvenous ICD leads. The long-term outcome and possible complications are as yet unknown in this population, and they should be monitored closely with follow-up DFTs.
authors.affiliation: Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. beth.stephenson@sickkids.ca
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stephenson
authors.forename: Anjan S
authors.initials: AS
authors.lastname: Batra
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
authors.forename: Robert M
authors.initials: RM
authors.lastname: Gow
authors.forename: Rainer
authors.initials: R
authors.lastname: Gradaus
authors.forename: Seshadri
authors.initials: S
authors.lastname: Balaji
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dubin
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rhee
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Ro
authors.forename: Anna M
authors.initials: AM
authors.lastname: Thøgersen
authors.forename: Frank
authors.initials: F
authors.lastname: Cecchin
authors.forename: John K
authors.initials: JK
authors.lastname: Triedman
authors.forename: Edward P
authors.initials: EP
authors.lastname: Walsh
authors.forename: Charles I
authors.initials: CI
authors.lastname: Berul
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable / Q000592:standards*; D004867:Equipment Design; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D007223:Infant; D013902:Radiography, Thoracic; D016896:Treatment Outcome