Epicardial Implantable Cardioverter-Defibrillator in a 2-Month-Old Infant

Sughimoto, Koichi; Tsuchida, Yuta; Hayashi, Hidenori; Torii, Shinzo; Kitamura, Tadashi; Horai, Tetsuya; Miyaji, Kagami

doi:10.1016/j.athoracsur.2016.08.040

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…Abdominal placement of the ICD generator is important in infants because placement in the thoracic cavity is spatially challenging, and the size of the device further complicates these challenges. Abdominal placement has been demonstrated by others as the least problematic location as well, 18 and similar feeding issues were noted in 1 of 8 patients in a similar study, also solved by reducing the escalation of feeding rate and volumes. 23 Chylothorax is also a known and significant postoperative concern in infants and smaller children undergoing cardiothoracic surgery, 31,32 which affected one of our patients.…”

Section: Discussionsupporting

confidence: 73%

“…This unique population has the added challenges of procedural complexity associated with device implantation, rapid growth in the first several years of life, markedly higher baseline and peak heart rates, and long-term ICD programming and management. 18,19 The risk of inappropriate shocks, system malfunction, and complications in this age group makes ICD use especially challenging. Although there are published case reports and several smaller studies, the literature is missing data on patient outcomes and ICD implantation approaches in infants and toddlers.…”

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confidence: 99%

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Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

Zahedivash

Hanisch

Dubin

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Limited data exist regarding implantable cardioverter defibrillator (ICD) usage in infants and toddlers. This study evaluates ICD placement indications, procedural techniques, programming strategies, and outcomes of ICDs in infants and toddlers. Methods: This is a single-center retrospective review of all patients ≤3 years old who received an ICD from 2009 to 2021. Results: Fifteen patients received an ICD at an age of 1.2 years (interquartile range [IQR], 0.1–2.4; 12 [80%] women; weight, 8.2 kg [IQR, 4.2–12.6]) and were followed for a median of 4.28 years (IQR, 1.40–5.53) or 64.2 patient-years. ICDs were placed for secondary prevention in 12 patients (80%). Diagnoses included 8 long-QT syndromes (53%), 4 idiopathic ventricular tachycardias/ventricular fibrillations (VFs; 27%), 1 recurrent ventricular tachycardia with cardiomyopathy (7%), 1 VF with left ventricular noncompaction (7%), and 1 catecholaminergic polymorphic ventricular tachycardia (7%). All implants were epicardial, with a coil in the pericardial space. Intraoperative defibrillation safety testing was attempted in 11 patients (73%), with VF induced in 8 (53%). Successful restoration of sinus rhythm was achieved in all tested patients with a median of 9 (IQR, 7.3–11.3) J or 0.90 (IQR, 0.68–1.04) J/kg. Complications consisted of 1 postoperative chylothorax and 3 episodes of feeding intolerance. VF detection was programmed to 250 (IQR, 240–250) ms with first shock delivering 10 (IQR, 5–15) J or 1.1 (IQR, 0.8–1.4) J/kg. Three patients (20%) received appropriate shocks for ventricular tachycardia/VF. No patient received an inappropriate shock. There were 2 (13%) ventricular lead fractures (at 2.6 and 4.2 years post-implant), 1 (7%) pocket-site infection, and 2 (13%) generator exchanges. All patients were alive, and 1 patient (7%) received a heart transplant. Conclusions: ICDs can be safely and effectively placed for sudden death prevention in infants and toddlers with good midterm outcomes.

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Section: Discussionsupporting

confidence: 73%

mentioning

confidence: 99%

Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

Zahedivash

Hanisch

Dubin

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…Five case reports and nine case series reported cases of appropriate successful shocks during follow up. Successful application of ATP for VT is mentioned in one pediatric case report 17 . Three pediatric case series described inappropriate shocks due to conductor fracture, insulation break, and failed discrimination of atrial tachycardias.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

Completely epicardial implantable cardioverter/defibrillator (ICD) and CRT‐D systems: A case series and systematic literature review

Tonko

Blauth

Rosenthal

et al. 2021

Pacing Clinical Electrophis

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Background Epicardial ICD systems and CRT‐Ds using high voltage coils represent an alternative to transvenous systems in patients without central venous access and prior device complications including infection. Objective We present a case series in the adult population of epicardial ICD/CRTD systems using high voltage epicardial coils. We summarize the existing data regarding techniques, efficacy, and safety. Methods A retrospective board approved medical record review was conducted for all patients undergoing epicardial ICD/CRTD placement at our institution between January 2010 and May 2020. The literature was reviewed for prior published trials, case reports, and case series of epicardial high voltage coil insertions. Results Eleven patients (six female, mean age 48 years) underwent epicardial ICD/CRTD implant including 5/11 completely epicardial CRTD systems. The procedure was performed via median sternotomy in eight patients, left anterior thoracotomy in two patients, and sub‐xiphoid approach in one patient. After a mean follow up of 35 months, appropriate successful shocks were delivered in two (18%) patients and no patients received an inappropriate shock. Three of five (60%) patients had volumetric remodeling with CRT with significant improvement of LV EF. Device‐related complications requiring a surgical/percutaneous revision or another DFT test occurred in six patients (54%). One patient died during follow up due to refractory heart failure. No cases of epicardial device infection, coronary artery compression, constrictive pericarditis, or erosion of defibrillator coils into intrathoracic organs were reported. No randomized studies comparing safety and efficacy of traditional transvenous or subcutaneous ICD systems and epicardial ICD systems using contemporary high voltage coils were found nor any studies directly comparing epicardial defibrillator patches versus epicardial coils. Thirteen case series and 24 single case reports published between 2004 and 2020 were identified describing in total a heterogenous group of 188 patients with ICD systems incorporating one or more epi‐ or pericardially positioned shock coils. Conclusion The use of epicardial defibrillation coils for ICD/CRT‐D is a feasible treatment option for patients with either failed or contraindicated transvenous ICD systems. Dedicated epicardial high voltage leads with integrated pace‐sense electrodes and specialized delivery tools for minimal invasive implantations may improve longer term outcomes.

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Implantation of a cardioverter-defibrillator in an 8-kg infant: a case report and literature review

2022

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The use of an implantable cardioverter-defibrillator to prevent sudden cardiac death is an approved method. Experience is limited regarding implantation techniques in infants and low-weight children. We herein describe the implantation of an epicardial implantable cardioverter-defibrillator in a 15-month-old infant weighing 8 kg. We also briefly discuss implantable cardioverter-defibrillator implantation in paediatrics, particularly infants, hoping that our experience will be drawn upon in further such attempts.

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Epicardial Implantable Cardioverter-Defibrillator in a 2-Month-Old Infant

Cited by 3 publications

References 5 publications

Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

Implantable Cardioverter Defibrillators in Infants and Toddlers: Indications, Placement, Programming, and Outcomes

Completely epicardial implantable cardioverter/defibrillator (ICD) and CRT‐D systems: A case series and systematic literature review

Implantation of a cardioverter-defibrillator in an 8-kg infant: a case report and literature review

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