A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population

Elizabeth A. Stephenson, Anjan S. Batra, Timothy K. Knilans, Robert M. Gow, Rainer Gradaus, Seshadri Balaji, Anne M. Dubin, Edward K. Rhee, Pamela S. Ro, Anna M. Thøgersen, Frank Cecchin, John K. Triedman, Edward P. Walsh, Charles I. Berul

Research output: Contribution to journalArticle

180 Scopus citations

Abstract

Introduction: 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.

Original languageEnglish (US)
Pages (from-to)41-46
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number1
DOIs
Publication statusPublished - Jan 2006

Keywords

  • Congenital heart disease
  • Implantable defibrillator
  • Pediatric

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

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