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. 2016 Aug;16(8):630-634.
doi: 10.5152/AnatolJCardiol.2015.6589. Epub 2015 Nov 18.

Subcutaneous defibrillator implantation in pediatric patients

İlker Ertuğrul  1 , Tevfik Karagöz  1 , Hakan Aykan  1 , Işıl Yıldırım  2 , Sema Özer  1 , Heves Karagöz  3 , Mustafa Yılmaz  4
Affiliations

Subcutaneous defibrillator implantation in pediatric patients

İlker Ertuğrul et al. Anatol J Cardiol. 2016 Aug.

Abstract

Objective: Although sudden cardiac death is rare in children, an intracardiac defibrillator system is indicated in children with various types of cardiomyopathy, primary electrical diseases, and after surgical repair of congenital heart defects. The use of transvenous defibrillator lead systems is limited in pediatric patients because of a small body size and/or limited vascular access. Subcutaneous array leads combined with an abdominally placed generator can enable implantation.

Method: This is a retrospective study of 13 patients who underwent subcutaneous defibrillator implantation between September 2010 and March 2015. The subcutaneous system was preferred because patients were not amenable to transvenous lead placement.

Results: The median patient age was 4.1 years, and the median patient weight was 12.1 kg. Diagnoses of patients were long-QT syndrome in 6, aborted cardiac arrest with left ventricular non-compaction in 3, hypertrophic cardiomyopathy with sustained ventricular tachycardia in 3, and arrythmogenic right ventricular cardiomyopathy in 1. Revision of the subcutaneous lead was required in 5 patients 2-26 months after the implantation. Appropriate shocks were observed in three patients. Inappropriate shock and lead fractures were observed in one patient during the follow-up period. The failure of therapy was observed in one patient. There were no perioperative complications and no early or late deaths.

Conclusion: Subcutaneous defibrillator systems are safe and effective in pediatric patients when the transvenous method is risky and contraindicated. Because the high growth rate in this population leads to lead failures, a close follow-up of this population is essential.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Revision of lead configuration by an additional lead 2 years after the implantation
Figure 2
Figure 2
Failure of therapy sinus rhythm restored after 4th shock with 35 J
See this image and copyright information in PMC

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