Extravascular Cardioverter‐Defibrillator for Primary Prevention in an 11‐Year‐Old Boy With Phenotype of High Risk Overlapping Cardiomyopathies

BACKGROUND: The extravascular implantable cardioverter-defibrillator (EV-ICD; Aurora™, Medtronic) is a novel non-transvenous system introduced in 2023. While its safety and efficacy have been demonstrated in adults, experience in pediatric patients remains limited despite potential advantages in this population. CASE PRESENTATION: We report an 11-year-old boy with complex cardiomyopathy (hypertrophic, dilated, and noncompaction) and high risk of sudden cardiac death (HCM Risk-Kids score 15.6%). Due to the absence of pacing indications and unsuccessful subcutaneous ICD screening, an EV-ICD was selected. The device was implanted via a minimally invasive retrosternal approach without complications. Excellent sensing and pacing parameters were achieved, and the patient was discharged in good condition. RESULTS: The implantation was feasible and safe, with stable electrical parameters and no perioperative complications. The close proximity of the substernal lead to the myocardium likely contributed to favorable device performance. CONCLUSION: EV-ICD implantation may be a viable alternative to transvenous systems in selected pediatric patients. Further studies and long-term follow-up are required to evaluate device performance during growth and development.