Methods: A retrospective review of the Electrophysiology database was used to identify surgical pediatric ICD implantations. Type of device, type of leads, lead number and position were obtained. Follow-up included any device related reoperations, wound or device infections, device or lead failure, and length of lead and device life.
Results: Eight patients underwent placement of an ICD via a subxiphoid/sternotomy approach utilizing pericardial coil placement at a mean age of 76.5 months (61-103) . In two patients, a prior transvenous coil and/or subcutaneous patch had been implanted at 17 and 21 months respectively- both patients presented with infection requiring removal and replacement of the entire system. During a mean follow-up of 35 months (2-84) since coil placement, one patient has undergone reoperation for coil fracture. All devices and coils remain in place and functional.
Conclusions: Epicardial placement of defibrillator coil is an effective and well tolerated approach to managing arrhythmia in the challenging pediatric population. In addition to being effective, complication rate are low compared with other approaches. This modality can be applied to very young children.