Surgical techniques for implanting implantable cardioverter defibrillators in children and infants

Abstract

Implantable cardioverter defibrillators (ICDs) are now being used in children. ICDs can be used to prevent sudden cardiac death caused by not only congenital heart defects, but also various non-structural diseases, such as long QT syndrome. However, a standard implantation technique for children, especially infants, has not yet been established. As the surgical implantation in infants is not amenable to transvenous lead placement, it was necessary to choose from epicardial, subcutaneous and pericardial ICD systems. However, many of these systems are associated with high rates of late complications. Lead fracture, insulation breakage, migration, buckling or crinkling of the patch lead and constrictive pericarditis have been reported as the most common lead-related complications. An increase in the defibrillation threshold is another issue that must be considered when using an ICD in a child or infant. Further studies on the outcomes, psychosomatic impact and other specific complications in the pediatric population need to be considered. The clinical use of ICDs in infants is still limited. Therefore, it is important to have many surgical options available so that the treatment can be custom-tailored to suit individual patients.

Epicardially placed implantable cardioverter‐defibrillator for a child with congenital long QT syndrome

“…As a result, established methods of pediatric ICD implantation are lacking, and long‐term outcomes are still unclear. Non‐transvenous ICD systems are required in children [1,2], and we chose an epicardial system for our case. The advantage of this system is that the defibrillation threshold is lower than that with a subcutaneous system, and cardiac strangulation caused by the leads is less likely than with a pericardial system [2].…”

“…Non‐transvenous ICD systems are required in children [1,2], and we chose an epicardial system for our case. The advantage of this system is that the defibrillation threshold is lower than that with a subcutaneous system, and cardiac strangulation caused by the leads is less likely than with a pericardial system [2]. Because the heart was sandwiched between the transverse sinus and the can located in the abdomen, we expected a lower defibrillation threshold.…”

“…An implantable cardioverter‐defibrillator (ICD) effectively prevents sudden cardiac death. However, methods for ICD implantation in children have not been established [1,2]. Here, we present the case of a pediatric patient with a successfully implanted ICD using an epicardial lead system.…”

A different surgical technique for cardioverter defibrillator implantation in pediatric patients: Pericardial-pleural pocket

“…However, a standard implantation technique for children, particularly for infants, has not been established, yet. [2] Transvenous lead placement is not possible for infants and young children due to the presence of small vessel diameters. Therefore, epicardial, subcutaneous, and pericardial ICD implantations should be considered.…”

“…To date, many techniques have been described by several authors. [1][2][3] Herein, we present our new technique applied in three pediatric patients.…”