Initial Experience of the Medtronic Aurora Extravascular Implantable Cardioverter in Children in a UK Centre

Implantation of an implantable cardioverter-defibrillator (ICD) in childhood comes with many challenges due to implantation of a device early in life, the small patient size and ongoing growth. The Aurora EV-ICD is the smallest extravascular device with a novel implantation technique. Implantation of the Aurora EV-ICD was performed in three paediatric patients in our institution between September 2024 and February 2025. The ages of the patients were 6, 12 and 16 years. The weight range was 20 to 45 kg, and the height range was 121 to 161 cm. The procedure was performed under general anaesthesia. The implantation was uneventful in all cases. A 52 cm EV2401 lead was implanted using the provided tunnelling tool with excellent sensing and pacing parameters. The Aurora EV-ICD^TM MRI SureScan^TM system was placed in a subcutaneous pocket in the left axilla. Defibrillation testing was successful in 2 cases (after a single 30 J shock); ventricular fibrillation was not induced successfully in one of the cases. The routine 6-week post-operative ICD interrogation was satisfactory for all cases with stable sensed R wave measurements. The novel use of the Aurora EV-ICD may mark a significant development in the realm of ICDs for children by circumventing complications linked to transvenous leads, preserving vascular integrity and offering the smallest available extravascular ICD option. Our experience shows that this novel ICD can be implanted successfully in the pediatric population, but evidence on long-term functionality of the device in children is required.