Initial experience with the extravascular implantable cardioverter-defibrillator in pediatric patients

Background: There is growing experience worldwide with the extravascular implantable cardioverter-defibrillator (EV-ICD). It is a single-lead implantable cardioverter-defibrillator that is implanted behind the sternum and can provide emergency pacing. Objective: We describe the initial experience of 12 implantations in pediatric patients at our hospital. Methods: The data on all Aurora EV-ICD (Medtronic) implantations from a single center from May 2024 to April 2025 were reviewed. Patient demographics, procedural characteristics, complications, outcome data, and device follow-up data were reviewed. The data are presented as medians and ranges. Results: A total of 12 patients underwent implantation of the EV-ICD. The median age at the time of implantation was 14.5 years (9-16 years), and the median weight was 51 kg (27-82 kg). All patients underwent successful implantation. There was 1 pleural lead placement, which was rectified 5 days later; there were no other complications. The median procedure time was 1 hour and 50 minutes (range 1 hour and 43 minutes to 2 hours and 14 minutes), and the median fluoroscopy time was 2 minutes and 12 seconds (range 1 minute and 34 seconds to 3 minutes and 23 seconds). Except for the lead repositioning, no patients required extraction of the device to date, nor have any received inappropriate shocks. Device parameters such as sensing and impedance remained stable over time. Conclusion: The EV-ICD can safely be implanted in pediatric patients with good short-term results. Further studies are required to establish the longer-term safety of the device in young people.