title: Subcutaneous defibrillator implantation in pediatric patients.
abstract: OBJECTIVE
  Although sudden cardiac death is rare in children, an intracardiac defibrillator system is indicated in children with various types of cardiomyopathy, primary electrical diseases, and after surgical repair of congenital heart defects. The use of transvenous defibrillator lead systems is limited in pediatric patients because of a small body size and/or limited vascular access. Subcutaneous array leads combined with an abdominally placed generator can enable implantation.
  
  
  METHODS
  This is a retrospective study of 13 patients who underwent subcutaneous defibrillator implantation between September 2010 and March 2015. The subcutaneous system was preferred because patients were not amenable to transvenous lead placement.
  
  
  RESULTS
  The median patient age was 4.1 years, and the median patient weight was 12.1 kg. Diagnoses of patients were long-QT syndrome in 6, aborted cardiac arrest with left ventricular non-compaction in 3, hypertrophic cardiomyopathy with sustained ventricular tachycardia in 3, and arrythmogenic right ventricular cardiomyopathy in 1. Revision of the subcutaneous lead was required in 5 patients 2-26 months after the implantation. Appropriate shocks were observed in three patients. Inappropriate shock and lead fractures were observed in one patient during the follow-up period. The failure of therapy was observed in one patient. There were no perioperative complications and no early or late deaths.
  
  
  CONCLUSIONS
  Subcutaneous defibrillator systems are safe and effective in pediatric patients when the transvenous method is risky and contraindicated. Because the high growth rate in this population leads to lead failures, a close follow-up of this population is essential.
authors.affiliation: Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: İlker
authors.initials: İ
authors.lastname: Ertuğrul
authors.affiliation: Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Karagöz
authors.affiliation: Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Aykan
authors.affiliation: Pediatric Cardiology, Koç University Hospital, İstanbul-Turkey.
authors.forename: Işıl
authors.initials: I
authors.lastname: Yıldırım
authors.affiliation: Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: Sema
authors.initials: S
authors.lastname: Özer
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: Heves
authors.initials: H
authors.lastname: Karagöz
authors.affiliation: Department of Cardiovascular Surgery, Faculty of Medicine, Hacettepe University, Ankara-Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yılmaz