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Epicardial and pleural lead ICD systems in children and adolescents maintain functionality over 5 years


Tomaske, M; Prêtre, René; Rahn, M; Bauersfeld, U (2008). Epicardial and pleural lead ICD systems in children and adolescents maintain functionality over 5 years. Europace, 10(10):1152-1156.

Abstract

AIMS: The optimal implantable cardioverter defibrillator (ICD) system implant technique has not yet been defined in young patients and those with congenital heart disease (CHD). We describe our 5-year experience with epicardial pacing/sensing leads secured on the left cardiac chambers and a pleural defibrillation lead insertion along the third intercostal space. METHODS AND RESULTS: Implantable cardioverter defibrillator systems were implanted in 15 children and adolescents (age: 2.9-20.0 years) for primary (n = 11) or secondary (n = 4) prevention. Underlying CHD were hypertrophic (n = 10) or dilative cardiomyopathies (n = 2), primary electrical diseases (n = 2), and transposition of the great arteries (n = 1). Devices were placed in the rectus sheath (n = 5), or within the diaphragm (n = 10). Median defibrillation threshold at implant was 15 J (range: 10-25). During 5 years of follow-up (median: 22 months), nine appropriate and two inappropriate ICD discharges occurred. Four system revisions were required due to device recall, pleural lead dislodgement, epicardial lead fracture, and insulation break. Twelve months after the implantation, defibrillation threshold testing demonstrated stable thresholds of <or=20 J in five patients. CONCLUSION: Our 5-year experience demonstrates the efficacy of epicardial and pleural lead ICD systems. Inappropriate shocks and lead failures are observed as in other ICD systems. It represents an alternative implant technique for young and active patients and those without venous access.

Abstract

AIMS: The optimal implantable cardioverter defibrillator (ICD) system implant technique has not yet been defined in young patients and those with congenital heart disease (CHD). We describe our 5-year experience with epicardial pacing/sensing leads secured on the left cardiac chambers and a pleural defibrillation lead insertion along the third intercostal space. METHODS AND RESULTS: Implantable cardioverter defibrillator systems were implanted in 15 children and adolescents (age: 2.9-20.0 years) for primary (n = 11) or secondary (n = 4) prevention. Underlying CHD were hypertrophic (n = 10) or dilative cardiomyopathies (n = 2), primary electrical diseases (n = 2), and transposition of the great arteries (n = 1). Devices were placed in the rectus sheath (n = 5), or within the diaphragm (n = 10). Median defibrillation threshold at implant was 15 J (range: 10-25). During 5 years of follow-up (median: 22 months), nine appropriate and two inappropriate ICD discharges occurred. Four system revisions were required due to device recall, pleural lead dislodgement, epicardial lead fracture, and insulation break. Twelve months after the implantation, defibrillation threshold testing demonstrated stable thresholds of <or=20 J in five patients. CONCLUSION: Our 5-year experience demonstrates the efficacy of epicardial and pleural lead ICD systems. Inappropriate shocks and lead failures are observed as in other ICD systems. It represents an alternative implant technique for young and active patients and those without venous access.

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10 citations in Web of Science®
13 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Children's Hospital Zurich > Clinic for Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Children's Hospital Zurich > Medical Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2008
Deposited On:28 Jan 2009 14:02
Last Modified:05 Apr 2016 12:54
Publisher:Oxford University Press
ISSN:1099-5129
Publisher DOI:https://doi.org/10.1093/europace/eun214
PubMed ID:18701602

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