| Abstract: | ![]()
Background. Novel nontransvenous implantable cardioverter defibrillator (ICD) configurations are sometimes required for small children and children with complex congenital heart disease at risk for sudden death. Mid‐ to long‐term follow‐up of these nontraditional implant techniques is not well known. We assessed the mid‐term performance of a subcutaneous lead technique used in our practice. Methods. Between July 2002 and November 2003, 4 patients (age 2.1–8.5 years, weight 13–33.3 kg, height 90–126.7 cm) received an ICD with a single‐finger (n = 3) or 2‐finger (n = 1) subcutaneous array with an active abdominal can and epicardial pace/sense lead. The subcutaneous tunnel was created via a subxiphoid incision using a tunneling tool within a sheath along the seventh intercostal space and extended posterior to the spine. Diagnoses included long QT syndrome (n = 2), idiopathic ventricular fibrillation (n = 1), and idiopathic dilated cardiomyopathy (n = 1). Implantable cardioverter defibrillator indications included syncope (n = 2) and cardiac arrest (n = 2). Results. Mean follow‐up was 22.3 ± 13.9 months. During follow‐up, 1 patient underwent heart transplantation and the other 3 patients underwent generator replacement secondary to a manufacturer’s advisory. There was 1 appropriate and successful shock for ventricular fibrillation. This patient experienced a second episode of ventricular fibrillation that the ICD discharge failed to terminate. The arrhythmia spontaneously resolved. There were no inappropriate shocks. There was 1 instance of false detection of ventricular fibrillation because of intermittent T wave oversensing but therapy was not administered. There were no infections, lead fractures, or other complications during follow‐up. Conclusion. This novel nontransvenous ICD configuration can be used safely in a select group of pediatric patients and allows for the applicability of this life‐saving technology to small children at high risk for sudden cardiac death. |
