Abstract 12993: Subcutaneous Implantable Cardioverter Defibrillator In Pediatric Patients; Early Experience
The subcutaneous implantable cardioverter defibrillator (S- ICD) (Cameron Health Inc) does not require lead(s) on or in the heart and has potential benefits in children, as mortality and morbidity of conventional ICDs in children largely relate to problems with transvenous leads. We describe the initial use of the S-ICD in 4 children <16 years. Three of the children, all boys aged 11, 9 and 15, presented with VF arrest and were subsequently found to have a mutation on HERG, hypertrophic cardiomyopathy and no current underlying diagnosis respectively. The 4th patient, a girl, 14 years, had an established diagnosis of CPVT with syncopal episodes despite nadolol. All three boys made an excellent neurological recovery. One developed a chronic infected tibial sinus from interosseous needle insertion and another developed severe subglottic stenosis from traumatic intubation requiring a tracheostomy, which became infected. We chose to implant the S-ICD system under general anaesthesia with a cardiac surgeon. The children's weights were 32, 34.5, 103 and 54kg. A subcutaneous pocket was made at the level of the 5th intercostal space in the mid-axillary line. The tripolar lead was first tunnelled from the pocket to an incision at the lower left sternum and then to an incision at the upper left sternum. The lead was secured to underlying muscle at the distal tip and also with a suture sleeve near the xiphoid. VF induced from the S-ICD was appropriately detected and converted to NSR with 65J. One boy required 3 post shock pacing pulses until his intrinsic rate was >50bpm. Time to therapy was 12–18 s. Surgery and postoperative recovery were uncomplicated. All patients were prescribed beta-blockers. Follow-ups range from 1 −7 months and all remain well with no shocks delivered. The S-ICD eliminates venous occlusion, endovascular infection, cardiac perforation, interference with valve function and risks of endocardial lead extraction. We have shown that it can be safely implanted in children >30Kg and will prove to be the ICD of choice in the group who do not require chronic pacing. A smaller version for children <30Kg, should be possible.
- © 2010 by American Heart Association, Inc.