Minimally Invasive Cardioverter Defibrillator Implantation for Children: An Animal Model and Pediatric Case Report
Article first published online: 22 JUL 2003
© Futura Publishing Company, Inc. 2001
Pacing and Clinical Electrophysiology
Volume 24, Issue 12, pages 1789–1794, December 2001
How to Cite
BERUL, C. I., TRIEDMAN, J. K., FORBESS, J., BEVILACQUA, L. M., ALEXANDER, M. E., DAHLBY, D., GILKERSON, J. O. and WALSH, E. P. (2001), Minimally Invasive Cardioverter Defibrillator Implantation for Children: An Animal Model and Pediatric Case Report. Pacing and Clinical Electrophysiology, 24: 1789–1794. doi: 10.1046/j.1460-9592.2001.01789.x
- Issue published online: 22 JUL 2003
- Article first published online: 22 JUL 2003
- Received August 14, 2001; revised September 6, 2001, accepted September 20, 2001.
- Cited By
- cardioverter defibrillator;
- animal models
BERUL, C.I., et al.: Minimally Invasive Cardioverter Defibrillator Implantation for Children: An Animal Model and Pediatric Case Report. The smaller venous capacitance in infants and small children may hamper transvenous ICD lead implantation, and epicardial approaches require thoracotomy and have associated complications. The study evaluated the feasibility and performance of subcutaneous arrays and active can ICDs without transvenous shocking coils or epicardial patches. An immature and mature pig were anesthetized and ventilated. A pacing lead was inserted in the right ventricle for fibrillation induction and rate sensing. Subcutaneous arrays were positioned in the right and left chest walls. An ICD emulator was placed in abdominal and prepectoral pockets. Fluoroscopic images were acquired for each electrical vector configuration (array can, can array, array array, array + array can). Ventricular fibrillation was induced and DFT testing performed. Defibrillation was achieved in all ten trials in the immature piglet, with DFT ≤ 9 J, regardless of vector configuration. Using a single subcutaneous array and active can, the shock impedance ranged from 28–36 ohms. With two arrays, shocking impedance fell to 15–22 ohms. In the adult pig, defibrillation was not accomplished with maximum energy of 40 J, using all vector configurations. Using data garnered from these experiments, this technique was then successfully performed in a 2-year-old child with VT and repaired congenital heart disease, needing an ICD. This study demonstrates the feasibility of leadless ICD implantation in an immature animal and successful implementation in a small child. A single subcutaneous array and active can resulted in excellent implant characteristics and DFTs with a minimally invasive approach. Defibrillation was not possible in a larger animal, possibly due to maximal available energy. This may be of value for small children requiring ICD implantation.