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Size Should Not Limit ICD Use In Children

Friday, October 19, 2012
Room 275-277 (Morial Convention Center)
Jeffrey M. Pearl, MD, Mitchell Cohen, Andrew Papez and Jennifer Schaffer, R.N., N.P., Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ

Purpose: Inherited or acquired dysrhythmia in pediatrics is often overlooked, despite a relatively high occurrence. Similar to management in adults, implantable defibrillator placement represents optimal therapy for many patients . However, unlike  adults, the small size of the heart, veins, and patients make implantation of these devices much more challenging and invasive.  In fact, size is often a limiting factor in the type of device placed, or even if a device can be placed at all until the patient is bigger. We have taken an aggressive approach to applying the appropriate therapy regardless of age and size, challenging the standard approach. We have adopted a strategy of epicardial placement of defibrillator coil in smaller patients requiring defibrillator therapy.

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.