Extravascular Implantable Cardioverter-Defibrillator (ICD) Systems in Children

Aims:In the pediatric population, implantable cardioverter-defibrillator (ICD) therapy is indicated for primary and secondary prevention of sudden cardiac death (SCD).We present our experience with non-transvenous ICD system implantation in 28 out of 98 pediatric patients treated with an ICD in the Children's Memorial Health Institute in Warsaw, Poland from August 2004 to March 2021. Methods and results:We analyzed a group of 28 children at a mean age of 6.6 years with a mean weight of 22.7 kg at the time of implantation.The surgical technique included a small left anterolateral thoracotomy with the placement of sub-pleural ICD leads in 22 children (78%) and a sternotomy with pericardial ICD leads in 6 children (22%).In 5 of the 6 sternotomy patients, an ICD lead was placed through the epicardial transverse sinus; in 1 patient, an epicardial ICD patch was implanted. Conclusion:There is no uniform methodology for the implantation of non-transvenous ICD systems in children.The method of implantation should be individually selected based on the patient's weight and whether there are any congenital heart defects or an ICD system is implanted when repairing a heart defect.Most of our patients had a sub-pleural high-energy lead implanted with an ICD generator placed under the left costal arch.In our experience, such a lead and ICD generator placement is optimal in small children.Placing the defibrillator in the pocket under the left thoracic arch enables relatively safe and uncomplicated replacement when the battery is depleted.