Intermuscular S-ICD Implantation in Pediatric Patients

Abstract

The use of conventional implantable cardioverter-defibrillators (ICDs) in children presents important technical challenges. We present the surgical technique necessary to adapt the subcutaneous ICD (S-ICD) implantation designed for adults, to children, including patients weighing less than 20 kg. The implant procedure implies a two-incision technique and interfascial serratus anterior–latissimus dorsi dissection to accommodate the device. S-ICD implantation was successfully performed in three patients of 19, 28, and 24 kg, respectively, two of them suffered cardiorespiratory arrest. Intermuscular thoracic implantation of S-ICD might represent an effective strategy for primary or secondary prevention of sudden cardiac death in pediatric patients.

Serratus anterior plane block and postoperative pain control in obese patients undergoing S‐ICD implantation: A case series and literature analysis

“…Several studies propose its effectiveness in wall block for ICD implantation, 16–19 also reducing the implantation procedure time 20 . Cases of the use of this technique in the pediatric setting with a favorable outcome are described 21 . A case of implantation using a wall block in a patient with pectus excavatum, also with a favorable outcome, has been reported 22 .…”

“… 20 Cases of the use of this technique in the pediatric setting with a favorable outcome are described. 21 A case of implantation using a wall block in a patient with pectus excavatum, also with a favorable outcome, has been reported. 22 An overview of the literature reveals that wall block offers numerous advantages compared to deep sedation.…”

Sudden Cardiac Death in Children Affected by Cardiomyopathies: An Update on Risk Factors and Indications at Transvenous or Subcutaneous Implantable Defibrillators

“…To overcome many of the complications described in T-and NT-ICDs, the subcutaneous ICD (S-ICD) has been developed (80); however due to its size there are only few data supporting the use of such a device in children weighting <25-30 Kg (81), in whom the new intermuscular technique along with the twoincision technique may overcome some of the surgical challenges (33) (Figure 3).…”

Nerve Blocks for Postoperative Pain Management in Children Receiving Subcutaneous Implantable Cardioverter-Defibrillators: A Case Series

“…A subcutaneous implantable cardioverter-defibrillator (S-ICD) is an alternative to a transvenous implantable cardioverter-defibrillator (TV-ICD) for children and those at risk for lead complications. [1][2][3][4] However, patients can experience significant postoperative pain due to the large S-ICD and sternal lead placement. 1,2,5 Adult studies of S-ICD implants have demonstrated that regional anesthesia may reduce postoperative opioid consumption.…”

“…[1][2][3][4] However, patients can experience significant postoperative pain due to the large S-ICD and sternal lead placement. 1,2,5 Adult studies of S-ICD implants have demonstrated that regional anesthesia may reduce postoperative opioid consumption. [6][7][8][9][10][11][12] Unfortunately, studies of nerve blocks for S-ICD placement in children are limited.…”