Document Detail


A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.
MedLine Citation:
PMID:  16426398     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
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
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 Jan 
Date Detail:
Created Date:  2006-01-23     Completed Date:  2006-05-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-6     Citation Subset:  IM    
Affiliation:
Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. beth.stephenson@sickkids.ca
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Arrhythmias, Cardiac / etiology,  physiopathology,  therapy*
Child
Child, Preschool
Defibrillators, Implantable / standards*
Equipment Design
Follow-Up Studies
Heart Defects, Congenital / complications*,  physiopathology,  radiography
Heart Rate
Humans
Infant
Radiography, Thoracic
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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