A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.
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.
Stephenson
Elizabeth A
EA
Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. beth.stephenson@sickkids.ca
Batra
Anjan S
AS
Knilans
Timothy K
TK
Gow
Robert M
RM
Gradaus
Rainer
R
Balaji
Seshadri
S
Dubin
Anne M
AM
Rhee
Edward K
EK
Ro
Pamela S
PS
Thøgersen
Anna M
AM
Cecchin
Frank
F
Triedman
John K
JK
Walsh
Edward P
EP
Berul
Charles I
CI
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