Conflict of Interest: None declared.
Subxiphoid Approach to Epicardial Implantation of Implantable Cardioverter Defibrillators in Children
Article first published online: 13 MAY 2013
©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 36, Issue 8, pages 926–930, August 2013
How to Cite
HAYDIN, S., SAYGI, M., ERGUL, Y., OZYILMAZ, I., OZTURK, E., AKDENIZ, C. and TUZCU, V. (2013), Subxiphoid Approach to Epicardial Implantation of Implantable Cardioverter Defibrillators in Children. Pacing and Clinical Electrophysiology, 36: 926–930. doi: 10.1111/pace.12158
- Issue published online: 25 JUL 2013
- Article first published online: 13 MAY 2013
- Manuscript Accepted: 14 MAR 2013
- Manuscript Revised: 1 MAR 2013
- Manuscript Received: 12 OCT 2012
- implantable cardioverter defibrillator;
Epicardial implantation of implantable cardioverter defibrillators (ICDs) is considered in the presence of intracardiac shunt, venous access issue, or small body size. We report our experience with epicardial ICD coil implantation using a minimally invasive method.
Nine patients who underwent epicardial ICD implantation were included. The median age was 7.4 years (3.9–9.6 years) and the median weight was 15 kg (12–24 kg). Diagnosis at the time of implantation included long QT syndrome (n = 5), catecholaminergic polymorphic ventricular tachycardia (n = 2), hypertrophic cardiomyopathy (n = 1), and fast monomorphic ventricular tachycardia (n = 1). The minimally invasive method involved a subxiphoid incision to place the epicardial pacing leads. The ICD coil was placed in the transverse sinus in four patients using an access path posterior to the heart. The second approach involved a path anterior to the heart to reach the epicardial location posterior to the left atrial appendage in the five remaining patients. No fluoroscopy was used in either approach. The median defibrillation threshold (DFT) at implantation was 7.5 J.
Lower DFTs were observed in the anterior approach (10 J vs 5 J). Appropriate ICD shocks were observed in three patients during the median 18-month follow-up period (0.3–28 months). No inappropriate shocks were noted. One patient developed pericardial tamponade 39 days after the procedure and was surgically drained.
Minimally invasive epicardial ICD coil implantation in children with low DFT values is possible. The anterior implantation approach appears superior to the posterior approach.