Effective cardioverter defibrillator implantation in children without thoracotomy: a valid alternative

The implantation method for a cardioverter defibrillator in children is poorly standardized because of obvious features related to size and predisposing cardiac disease in children presenting with malignant ventricular arrhythmia. We propose an alternative method of implanting a cardioverter defibrillator without the need for associated thoracotomy, based on the subxiphoidal insertion of an epicardial bipolar ventricular pacing and sensing lead, an active can placed in the abdomen, and a subcutaneous array tunneled along the left thoracic wall as a shock electrode. This technique offers the advantage of an effective and minimally invasive implantable cardioverter defibrillator with wide applicability for children, independent of their size and cardiac status.