Short- and Mid-term Outcomes of the Extravascular Implantable Cardioverter-defibrillator in Pediatric and Adolescent Patients: A Single-center Experience.

Experience with the Aurora extravascular (EV) implantable cardioverter-defibrillator (ICD) (Medtronic, Minneapolis, MN, USA) remains limited among pediatric centers in contrast to its broader implantation in adults. We evaluated our single-center experience with the EV ICD as part of our standard ICD options for treatment of malignant ventricular arrhythmias in pediatric subjects. Following approval for EV ICD implantation at our center, five consecutive adolescent patients underwent implantation over a 7-month period. Patient characteristics, qualification for EV ICD placement, nuances in EV ICD implantation in each patient, and post-implant follow-up were reviewed. A total of six out of eight consecutive ICD candidates were identified as potential EV ICD candidates, with five patients undergoing eventual EV ICD implantation (average age, 16.8 years [range, 14-19 years]; four males). Indications for ICD included genetic arrhythmias (n = 3) and hypertrophic cardiomyopathy (n = 2). All patients underwent successful implantation without intraoperative or early postoperative complications. No lead dislodgement, device migration, infection, or inappropriate shocks were observed. All patients demonstrated appropriate R-wave sensing and stable lead parameters at early (4- to 6-week) and mid-term (>3- to 6-month) follow-up. Post-implant exercise testing in two patients showed no significant P- or T-wave oversensing. EV ICD implantation is feasible and well tolerated in appropriately selected pediatric patients. Most pediatric ICD referrals were candidates for EV ICD implant when integrating the EV ICD in regular practice. Implant indications differ among pediatric versus adult EV ICD recipients. While early outcomes are favorable, long-term performance and applicability in smaller patients require further investigation.