Alpha-loop technique in implantable cardioverter-defibrillator lead implantation for elementary school-age children: A case series

The implantation of an implantable cardioverter-defibrillator (ICD) in pediatric patients may be performed using one of three approaches: transvenous (TV-ICD), epicardial, or subcutaneous (S-ICD). The epicardial approach is typically employed in infants or when venous access is limited; however, it has been associated with a relatively high incidence of lead malfunction, failure, and breakage.1 Although the safety and efficacy of S-ICD in patients younger than 18 years have been reported in recent years,2 challenges persist in smaller pediatric patients due to concerns regarding lead length and generator size.