Nontransvenous Implantable Cardioverter Defibrillator Systems: Not Just for Small Pediatric Patients

A computer modeling tool for comparing novel ICD electrode orientations in children and adults

“…Transvenous implantation often cannot be performed in children due to patient size, lack of vascular access and increased risk of embolic phenomena due to intracardiac shunts. 5,31 Children with ICDs have high rates both of lead failure and vascular occlusion, and also have long life expectancy compared to adult patients, resulting in the anticipated need for repeated lead extraction and reimplantation with their attendant risks. 1,6 There is now also growing interest in the development of extracardiac, subcutaneous ICDs for the adult population with normal cardiac anatomy, with the goal of simplifying ICD implantation, avoiding lead related complications, and/or addressing vascular access problems or other contraindications to transvenous implant.…”

“…[1][2][3][4] Although ICD systems are routinely implanted in adult patients using a transvenous approach, there is a growing population of pediatric and adult patients in whom transvenous ICD systems cannot or should not be implanted. 5 These include patients of very small size and those with intracardiac shunts or anatomical obstruction to lead placement. [6][7][8][9] In these patient populations, a variety of innovative approaches to ICD implantation have been reported, including subcutaneous, epicardial and caval electrode placements and/or abdominal can implants (Figure 1).…”

Care of the Pediatric Patient with a Device

“…Several clinical reports have highlighted the skill and innovation of pediatric cardiac surgeons who have successfully implanted ICDs in young infants using novel approaches (Gasparini et al 2005 ;Kriebel et al 2006 ;Kugler and Erickson The relatively larger size of ICDs compared with pacemakers and the need for a defi brillation coil or subcutaneous array add to the technical challenges of ICD implantation in small children.…”

Simpler is Better? Full Circle in Our Attempt to Decrease Cardioverter Defibrillator Inappropriate Shocks in the Young

“…Due to the inevitable need for transvenous lead extraction in this young population, the morbidity and even mortality may be less over time with a single rather than dual‐chamber ICD system. Although nontransvenous systems can be used both in small and large body sized patients, it appears prudent to maintain venous patency for transvenous systems as long as possible 11,12 . It seems reasonable that using single‐chamber systems would be in line with this goal.…”

“…Although nontransvenous systems can be used both in small and large body sized patients, it appears prudent to maintain venous patency for transvenous systems as long as possible. 11,12 It seems reasonable that using single-chamber systems would be in line with this goal.…”