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Pediatric SubQ-ICD implantation, a single center review of the inter-muscular technique
Daniel Cortez1, Kari Erickson2, Gurumurthy Hiremath1
1University of Minnesota/Masonic Children's Hospital, Minneapolis, USA.
Insights
The two-incision technique for subcutaneous implantable cardioverter defibrillators (ICDs) in children shows a lower complication rate than previous methods. This approach offers a safer option for pediatric patients at risk of sudden cardiac death.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Cardiac Electrophysiology
Background:
- Pediatric cardiomyopathies increase sudden death risk, necessitating implantable cardioverter defibrillators (ICDs).
- Children face higher ICD complication risks due to size and device duration.
- Subcutaneous ICDs (S-ICDs) are suitable for children without pacing needs, but prior techniques had high complication rates.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel two-incision technique for S-ICD implantation in pediatric patients.
- To compare complication rates of the two-incision S-ICD technique with historical data from three-incision methods.
Main Methods:
- Retrospective review of pediatric patients receiving S-ICDs without pacing indications using a two-incision technique.
- Analysis of patient demographics, follow-up duration, and complications.
- Impedance testing (10-J and 65-J) performed in a subset of patients.
Main Results:
- Twelve pediatric patients (median age 14 years, 72.7% male) were included.
- Median follow-up was 11.5 months, with one minor complication (incisional adhesive strip issue).
- Median shock impedance was 55 J; one appropriate shock/charge and no inappropriate shocks occurred.
Conclusions:
- The two-incision, intermuscular S-ICD technique demonstrated a lower acute complication rate in this pediatric cohort.
- This technique appears to be a safer alternative for S-ICD implantation in children compared to previous methods.
Introduction:
Pediatric patients with cardiomyopathies are at risk for sudden death and may need implantable cardioverter defibrillators (ICD's), but given their small size and duration of use, children are at increased risk for complications associated with ICD use. The subcutaneous ICD presents a favorable option for children without pacing indications. Unfortunately, initial pediatric studies have demonstrated a high complication rate, likely due to the 3-incision technique employed.
Material And Methods:
Patients with ICD but no pacing indication were retrospectively reviewed after implantation of subcutaneous ICD via the two-incision technique. In half of the patients, 10-J impedance test was also performed to compare with impedance obtained after defibrillation threshold testing with 65-J.
Results:
Twelve patients were included. The median age was 14 years (range 10-16 years) with eight males included (72.7%). The median weight was 55 kg (range 29 kg-75.1 kg). Follow-up had a median of 11.5 months (range 2-27 months). The median body mass index was 18.4 kg/m squared (range 15.5-27.9 kg/m squared). One patient suffered a minor complication after tearing off the incisional adhesive strips early and required a non-invasive repair in clinic. Shock impedance had a median of 55 J (range 48-68 J). There was one appropriate shock/charge and no inappropriate shocks during follow-up.
Conclusion:
The two-incision, intermuscular technique appears to have a lower acute complication rate than prior reports, in our cohort of 12 pediatric patients.
