Subcutaneous array leads with abdominally placed ICDs achieved safe defibrillation thresholds (≤20 J) and no complications over up to 6 years of follow-up in two children.
Case Report (n=2)
Does nonthoracotomy ICD placement using subcutaneous array leads and abdominally placed active cans provide safe defibrillation in children with complex congenital heart defects?
Nonthoracotomy ICD placement using subcutaneous array leads and abdominally placed active cans is a feasible and safe alternative for children with complex congenital heart disease precluding transvenous access.
INTRODUCTION: The need to access the right ventricle might preclude transvenous placement of a defibrillation lead at implantable cardioverter defibrillator (ICD) placement, especially in small children or children with complex congenital heart defects. We investigated a subcutaneous array lead in addition to an abdominally placed "active can" ICD device in two children to avoid a thoracotomy. METHODS AND RESULTS: The first child (age 12 years, 138 cm, 41 kg) had transposition of the great arteries with a subsequent surgical intra-atrial correction by the Mustard technique. The second child (age 14 years, 161 cm, 54 kg) had a single atrium and a single ventricle, d-transposition of the aorta, and atresia of the main pulmonary artery with a surgical anastomosis between the aorta and the right pulmonary artery by the Cooley technique. The defibrillation threshold was 18 J and <20 J at initial implantation and at generator replacement in the first patient and 20 J in the second patient. During follow-up of 6 years and 1 month, respectively, no ICD-related complications occurred. CONCLUSION: In children in whom endocardial, right ventricular placement of a defibrillation lead is precluded, defibrillation is possible and safe between an abdominally placed "active can" ICD device and a subcutaneous array lead. This approach may avoid a thoracotomy in children with no possibility for transvenous ICD placement.
Gradaus et al. (2001) conducted a case report in Complex congenital heart defects precluding transvenous ICD placement (n=2). Subcutaneous array lead and abdominally placed active can ICD was evaluated on Defibrillation threshold and ICD-related complications. Subcutaneous array leads with abdominally placed ICDs achieved safe defibrillation thresholds (≤20 J) and no complications over up to 6 years of follow-up in two children.