Nonthoracotomy Implantable Cardioverter Defibrillator Placement in Children: Use of Subcutaneous Array Leads and Abdominally Placed Implantable Cardioverter Defibrillators in Children
Article first published online: 13 AUG 2003
© Futura Publishing Company, Inc. 2001
Journal of Cardiovascular Electrophysiology
Volume 12, Issue 3, pages 356–360, March 2001
How to Cite
GRADAUS, R., HAMMEL, D., KOTTHOFF, S. and BÖCKER, D. (2001), Nonthoracotomy Implantable Cardioverter Defibrillator Placement in Children: Use of Subcutaneous Array Leads and Abdominally Placed Implantable Cardioverter Defibrillators in Children. Journal of Cardiovascular Electrophysiology, 12: 356–360. doi: 10.1046/j.1540-8167.2001.00356.x
- Issue published online: 13 AUG 2003
- Article first published online: 13 AUG 2003
- Manuscript received 25 September 2000; Accepted for publication 28 November 2000.
- Cited By
- implantable cardioverter defibrillator;
- subcutaneous abdominal implantation
Nonthoracotomy ICD in Children. Introduction: The need to access the right ventricle might preclude transvenous placement of a defibrillation lead at implantable cardioverter defibrillator (ICD) placement, especially in small children or children with complex congenital heart defects. We investigated a subcutaneous array lead in addition to an abdominally placed “active can” ICD device in two children to avoid a thoracotomy.
Methods and Results: The first child (age 12 years, 138 cm, 41 kg) had transposition of the great arteries with a subsequent surgical intra-atrial correction by the Mustard technique. The second child (age 14 years, 161 cm, 54 kg) had a single atrium and a single ventricle, d-transposition of the aorta, and atresia of the main pulmonary artery with a surgical anastomosis between the aorta and the right pulmonary artery by the Cooley technique. The defibrillation threshold was 18 J and < 20 J at initial implantation and at generator replacement in the first patient and 20 J in the second patient. During follow-up of 6 years and 1 month, respectively, no ICD-related complications occurred.
Conclusion: In children in whom endocardial, right ventricular placement of a defibrillation lead is precluded, defibrillation is possible and safe between an abdominally placed “active can” ICD device and a subcutaneous array lead. This approach may avoid a thoracotomy in children with no possibility for transvenous ICD placement.