Abstract 14479: First Experiences in Children and Young Adults with a Totally Subcutanous Implantable Cardioverter Defibrillator System
Objectives The risk of transvenous lead failure in young patients remains a major complication, including inappropriate shocks and system failure. We report our experiences with a totally subcutaneous implantable cardioverter defibrillator, S-ICD (Cameron Health, San Clemente, USA).
Methods We implanted the S-ICD system in 14 pts with mean +/- standard deviation (SD) aged of 25 +/- 7.2 years, (range 13 - 35 years), between August 2010 and June 2012. Indications for implantation were ion channelopathies, congenital heart disease, dilated cardiomyopathy and idiopathic ventricular fibrillation in 5, 4, 3 and 2 pts respectively. Mean + /- SD left ventricular ejection fraction was 41 +/- 16%, (range 10-55%). Implantation was for primary prevention in 8 pts and for secondary in 6 pts. All pts were implanted with an S-ICD system sub-muscularly between the anterior and posterior axillary lines via a left sub-mammary incision, under general anaesthesia. The electrode was tunnelled subcutaneously from the generator pocket to the xyphoid and then left parasternally towards the manubrial sternal junction.
Results 13 of 14 pts were tested intra-operatively and sustained ventricular fibrillation was converted to sinus rhythm with a 65 Joule standard polarity shock. 1 pt was not tested due to thrombus within the heart. There were no procedure related complications. Mean +/- SD follow-up of 313 +/-222 days (range 1-640 days) demonstrated 2 pts with shock therapy. A 13 year old male, Brugada Syndrome, received an inappropriate shock due to T wave over sensing on exercise. This was investigated with an exercise test and the secondary vector, tip to generator, was the only vector of the 3 available which demonstrated the over sensing. The primary vector, ring to generator, was programmed and the boy has been free of further therapy for 10 months. A 17 year old female with Long QT syndrome received 2 appropriate shocks which successfully terminated episodes of torsades-de-pointes within 2 months of implantation.
Conclusion The implantation of the S-ICD is safe and feasible in children and young adults. It represents an alternative in pts, who are otherwise at the risk of on-going transvenous lead complications and extractions.
- © 2012 by American Heart Association, Inc.