Subcutaneous array with active can implantable cardioverter defibrillator configuration: a follow-up study

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Medical Device Technology

Background:

• Novel nontransvenous implantable cardioverter defibrillator (ICD) configurations are crucial for pediatric patients with complex congenital heart disease at risk of sudden cardiac death.
• Mid- to long-term outcomes of these non-traditional implant techniques are not well-established.
• This study evaluates the mid-term performance of a subcutaneous lead technique in pediatric patients.

Purpose of the Study:

• To assess the mid-term performance and safety of a novel subcutaneous lead technique for implantable cardioverter defibrillators (ICDs) in pediatric patients.
• To determine the efficacy of this nontransvenous ICD configuration in managing life-threatening arrhythmias in children.
• To evaluate the applicability of ICD technology to small children at high risk for sudden cardiac death.

Main Methods:

• Four pediatric patients (ages 2.1-8.5 years) with conditions like long QT syndrome and idiopathic ventricular fibrillation received ICDs with subcutaneous arrays and epicardial leads.
• A subcutaneous tunnel was created using a subxiphoid incision and a tunneling tool.
• Implantable cardioverter defibrillator (ICD) indications included syncope and cardiac arrest.

Main Results:

• Mean follow-up was 22.3 months, with one patient undergoing heart transplantation and others requiring generator replacement due to a manufacturer advisory.
• One appropriate and successful shock for ventricular fibrillation was delivered; a second episode resolved spontaneously.
• No inappropriate shocks, infections, or lead fractures occurred, although one instance of T wave oversensing was noted without therapy administration.

Conclusions:

• This novel, nontransvenous implantable cardioverter defibrillator (ICD) configuration can be safely employed in select pediatric patients.
• The subcutaneous lead technique facilitates the use of life-saving ICD technology in small children at high risk for sudden cardiac death.
• The findings support the feasibility and safety of this approach for pediatric arrhythmia management.