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      Minimally invasive, pericardial implantable cardioverter-defibrillator placement in a young child

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          Abstract

          We report the successful minimally invasive placement of a pericardial implantable cardioverter-defibrillator (ICD) in a 16-kg child. A transvenous ICD dual coil was advanced through a small subxiphoid incision and screwed into the oblique sinus pericardium under fluoroscopic guidance. An additional sense-pace lead was sutured onto the right ventricular apex, and the generator was placed in the upper abdominal wall through the same incision. Threshold testing demonstrated successful defibrillation at 15 J. After implantation, the patient had two episodes of appropriate shock for ventricular fibrillation. The ICD system continues to show stable impedance at 6 months of follow-up.

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          A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.

          A M Thögersen, Neil Gow, Kathryn E Stephenson … (2005)
          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. Retrospective review at 10 centers implanting ICDs without a transvenous shocking coil or epicardial patches. 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. 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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            Novel minimally invasive, intrapericardial implantable cardioverter defibrillator coil system: a useful approach to arrhythmia therapy in children.

            Tain-Yen Hsia, Scott M Bradley, Martin J LaPage … (2009)
            Current approaches to implantable cardioverter defibrillator (ICD) implantation in children remain challenging. Transvenous access may be limited due to patient size or anatomy, while epicardial patches require sternotomy or thoracotomy. We present an alternative approach; minimally invasive placement of a transvenous ICD coil within the pericardial space with active fixation. Between August 2005 and October 2008, 7 children meeting indications for ICD therapy for ventricular tachyarrhythmias underwent intrapericardial placement of an ICD coil system. Median age was 5 years (range, 1 to 17), weight was 14 kg (range, 8 to 46), and 4 patients weighed less than 20 kg. The ICD system was composed of a single or dual defibrillation coil, an active can, and either ventricular or dual chamber epicardial sense-pace leads. All implantations were performed through a small subxiphoid incision and pericardial window without sternotomy. The coil lead was actively fixated in the transverse sinus under fluoroscopic guidance, and the generator placed in a subrectus pocket in the upper abdomen through the same incision. There were no perioperative complications, and no early or late deaths. All implants had acceptable defibrillation energies (range, 5 to 15 J) that were successfully tested intraoperatively, and none required energy increase or lead revision during follow-up (range, 1 to 39 months; median, 20 months). Impedance between the active can and the defibrillation coil remained stable in all. There were no inappropriate discharges. Thirty-six successful ICD discharges in 4 patients were recorded. Two patients underwent subsequent orthotopic heart transplantation and ICD system removal. Intrapericardial placement of an ICD coil system can be safely and successfully carried out through a minimally invasive subxiphoid approach in small infants and children. This novel ICD configuration demonstrates excellent performance, and provides a particularly efficacious approach to ventricular tachyarrhythmia therapy in pediatric patients.
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              Epicardially placed implantable cardioverter-defibrillator for a child with congenital long QT syndrome

              Hirotaro Sugiyama, Motomi Tachibana, Hiroshi Morita … (2016)
              A 7-year-old boy presented at our hospital with syncope. At birth, electrocardiography had shown a long QT interval with torsade de pointes (TdP). Congenital long QT syndrome (LQTS) had been diagnosed by genetic testing, and was successfully controlled with oral propranolol. At age 7, TdP had recurred with syncope. Electrocardiography revealed a prominent long QT interval with T-wave alternans. The propranolol dose was increased, but TdP remained uncontrolled. A cardioverter-defibrillator (ICD) was implanted epicardially, and TdP completely resolved with atrial pacing. We report this rare case of ICD implantation in a child with LQTS.
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                Author and article information

                Contributors
                Hiroko Asakai
                Journal
                Journal ID (nlm-ta): J Arrhythm
                Journal ID (iso-abbrev): J Arrhythm
                Title: Journal of Arrhythmia
                Publisher: Elsevier
                ISSN (Print): 1880-4276
                ISSN (Electronic): 1883-2148
                Publication date PMC-release: 26 July 2017
                Publication date (Print): October 2017
                Publication date (Electronic): 26 July 2017
                Volume: 33
                Issue: 5
                Pages: 523-524
                Affiliations
                [a ]University of Tokyo Hospital, Department of Pediatrics, 7-3-1 Hongo, Bunkyoku, Tokyo, Japan
                [b ]University of Tokyo Hospital, Department of Cardiac and Thoracic Surgery, 7-3-1 Hongo, Bunkyoku, Tokyo, Japan
                Author notes
                [* ]Corresponding author. asakai-tky@ 123456umin.ac.jp
                Article
                Publisher ID: S1880-4276(17)30121-7
                DOI: 10.1016/j.joa.2017.06.003
                PMC ID: 5634712
                SO-VID: c78be59c-d019-42b4-9c91-123fc7afb1fb
                Copyright © © 2017 Japanese Heart Rhythm Society. Published by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 12 April 2017
                Date revision received : 15 June 2017
                Date accepted : 22 June 2017
                Categories
                Subject: Case Report

                Keywords: icd,pericardial,minimally invasive,child
                Data availability:
                Keywords: icd, pericardial, minimally invasive, child

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