Case report: Removal of a subcutaneous implantable cardiac defibrillator in a pediatric patient with hypertrophic cardiomyopathy after a septal myectomy. Insights on current indications of type of ICD in children with hypertrophic cardiomyopathy and left ventricular tract obstruction

Abstract

Hypertrophic cardiomyopathy is a heart muscle disease with an annual incidence between 0.24 and 0.47/100000 in childhood. Sudden cardiac death is the most common cause of death in this population. Although some medical treatment can decrease the risk of sudden cardiac death, implantable cardioverter defibrillator continues to be the most reliable treatment. Different types of devices and programming strategies can be used in patients with hypertrophic cardiomyopathy depending on each center and specific patient condition. We report a pediatric patient affected with hypertrophic cardiomyopathy who had and ICD implantation in primary prevention. Four years later he developed symptomatic left ventricular outflow tract obstruction and a surgical septal myectomy was performed. After the myectomy the patient developed complete left bundle branch block on his 12 lead ECG, and unfortunately none of the S-ICD vectors were suitable after the myectomy and it had to be explanted and replaced for a new transvenous ICD.

Maintenance of Subcutaneous Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy Patients With Iatrogenic Left Bundle‐Branch Block After Septal Myectomy

“… 3 The second case in a pediatric patient required explant of the SICD post myectomy due to unsuitability of any sensing vector with consequent implant of a transvenous system. 4 In contrast, our experience suggests that maintenance of SICD in patients with HCM after the development of conduction abnormalities from septal myectomy might be feasible. Post myectomy, interrogation should include update of morphology templates and appropriate adjustment of sensing vectors.…”

“…The potential risks associated with maintaining SICDs in this population remain uncertain. 3 , 4 Therefore, we believe it is timely to describe our experience to help guide strategies for the prevention of oversensing and inappropriate shocks in these patients.…”