| A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population. | |
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MedLine Citation:
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PMID: 16426398 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Multicenter Study |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 17 ISSN: 1045-3873 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2006-01-23 Completed Date: 2006-05-04 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 41-6 Citation Subset: IM |
Affiliation:
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Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA. beth.stephenson@sickkids.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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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