Minimally invasive epicardial implantable cardioverter-defibrillator placement for infants and children: An effective alternative to the transvenous approach.
Young patients have high rates of implantable cardioverter-defibrillator (ICD) lead fractures and are at risk for venous occlusion or tricuspid regurgitation with transvenous lead placement. Epicardial ICDs have the potential to circumvent complications associated with transvenous ICDs, but the literature on young patients remains limited.



The purpose of this study was to evaluate the results of a minimally invasive epicardial ICD lead placement approach in young patients.



A retrospective, institutional review board-approved electronic medical record review of all patients undergoing epicardial ICD placement at our institution from January 2011 to December 2015 was performed.



A total of 46 patients (20 female [43%]; mean age 10.3 years, range 0.7-18.2 years; mean weight 41 ± 21 kg) were identified; 24 (52%) were ≤10 years old. A minithoracotomy was used in 28 patients (61%). All had acceptable defibrillation, right ventricular sensing, and stimulation thresholds. Median follow-up was 2.0 ± 1.3 years (range 0.02-4.5 years). Eight surgical complications occurred in 7 patients (15%), and 8 device-related complications occurred in 6 patients (13%). Fifty-eight appropriate shocks were delivered in 7 patients (15%). Four patients received inappropriate shocks in relation to lead fractures/microfractures. One patient in this cohort who had long QT syndrome type 8 died of a hypoglycemic seizure.



Minimally invasive epicardial ICD placement provides an effective, alternative method for implanting an ICD system, particularly in very young patients (<6 years of age) or patients who are concerned about cosmetic appearance. This technique is an acceptable alternative to traditional transvenous ICD placement.
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Andrew E
AE
Schneider
Department of Surgery/Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Harold M
HM
Burkhart
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Medicine/Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota,; Department of Molecular Pharmacology & Experimental Therapeutics/Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota.
Michael J
MJ
Ackerman
Department of Surgery/Division of Cardiothoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Joseph A
JA
Dearani
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota.
Philip
P
Wackel
Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota. Electronic address: cannon.bryan@mayo.edu.
Bryan C
BC
Cannon
D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010496:Pericardium / Q000601:surgery; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*
Epicardial ICD placement; Hypertrophic cardiomyopathy; Implantable cardioverter-defibrillator; Long QT syndrome; Minimally invasive surgical approach