A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.
A multicenter experience with novel implantable cardioverter defibrillator configurations in the pediatric and congenital heart disease population.
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DOI：
10.1111/j.1540-8167.2005.00271.x
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发表时间：
2005-09
影响因子：
2.7
通讯作者：
E. Stephenson;A. Batra;T. Knilans;R. Gow;R. Gradaus;S. Balaji;A. Dubin;E. Rhee;P. Ro;A. Thøgersen;F. Cecchin;J. Triedman;E. Walsh;C. Berul
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文献类型：
--
作者：
E. Stephenson;A. Batra;T. Knilans;R. Gow;R. Gradaus;S. Balaji;A. Dubin;E. Rhee;P. Ro;A. Thøgersen;F. Cecchin;J. Triedman;E. Walsh;C. Berul
INTRODUCTION In pediatric and congenital heart disease patients, transvenous ICD implantation may be limited secondary to patient size, venous, or cardiac anatomy. Epicardial patches require a thoracotomy, and may lead to a restrictive pericardial process. Because of these issues, we have explored novel ICD configurations. METHODS Retrospective review at 10 centers implanting ICDs without a transvenous shocking coil or epicardial patches. RESULTS Twenty-two patients underwent implant at a mean age of 8.9 years (range: 0.3-43.5), with a mean weight of 25.5 kg (range: 5.2-70). Diagnoses included complex CHD, intracardiac tumors, cardiomyopathy, idiopathic VT, LV noncompaction, and long QT syndrome. Three configurations were used: subcutaneous array, a transvenous design ICD lead placed on the epicardium, or a transvenous design ICD lead placed subcutaneously. Difficulties were found at implant in 8 patients: 4 had difficulty inducing VT/VF, and 4 had high DFTs. Over a mean follow-up of 2.2 years (range: 0.2-10.5), 7 patients had appropriate shocks. Inappropriate shocks occurred in 4 patients. System revisions were required in 7 patients: 2 generator changes (in 1 patient), 3 pace-sense lead replacement, 1 additional subcutaneous coil placement due to increased DFT, 1 upgrade to a transvenous system, and 1 revision to epicardial patch system. CONCLUSIONS ICD implantation can be performed without epicardial patches or transvenous high-energy leads in this population, using individualized techniques. This will allow ICD use in patients who have intracardiac shunting or are deemed too small for transvenous ICD leads. The long-term outcome and possible complications are as yet unknown in this population, and they should be monitored closely with follow-up DFTs.
