The Particulars: Previous studies have suggested that the rates of implantable cardioverter defibrillator (ICD) lead fractures are high among young patients. This patient population has also been found to be at risk for venous occlusion with transvenous ICD lead placement. A minimally invasive epicardial ICD placement may provide younger patients with a more desirable treatment alternative. Data Breakdown: Investigators reviewed the charts of 22 children who underwent ICD placement using an epicardial pace/sense lead and a separate coil that was placed laterally—posterior to the pericardial sack through a 2 cm submammary incision—and tunneled the leads to an abdominal generator. All patients in the study had successful ICD implantations, and there were no deaths at 20 months follow-up. One patient required a right ventricle lead replacement. Another patient experienced an ICD generator failure but did not have problems with the lead or coil. Two other patients required drainage of a pleural effusion. In five patients, 32 appropriate shocks were delivered, all of which were successful except for one patient who required a second shock on two occasions. Two inappropriate shocks occurred in one patient secondary to atrial fibrillation with a rapid ventricular response.
Take Home Pearl: Minimally invasive epicardial ICD placement appears to be an effective, cosmetically pleasing alternative to traditional ICD placement for young patients.