title: ICD Implantation in infants and small children: the extracardiac technique.
abstract: BACKGROUND
  There is no clear methodology for implantation of an internal cardioverter-defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients.
  
  
  METHODS
  An extracardiac ICD system was implanted in eight patients (age: 0.3-8 years; body weight: 4-29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid-eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as "active can" in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively.
  
  
  RESULTS
  In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow-up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break.
  
  
  CONCLUSIONS
  In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow-up are still limited. The course of the DFT is unknown, facing further growth of the patients.
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, FR Germany. tkriebe@gwdg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Kriebel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ruschewski
authors.forename: Maria
authors.initials: M
authors.lastname: Gonzalez y Gonzalez
authors.forename: Katharina
authors.initials: K
authors.lastname: Walter
authors.forename: Johannes
authors.initials: J
authors.lastname: Kroll
authors.forename: Christoph
authors.initials: C
authors.lastname: Kampmann
authors.forename: Markus
authors.initials: M
authors.lastname: Heinemann
authors.forename: Heike
authors.initials: H
authors.lastname: Schneider
authors.forename: Thomas
authors.initials: T
authors.lastname: Paul
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome