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J Thorac Cardiovasc Surg 2003;126:1657-1659
© 2003 The American Association for Thoracic Surgery

Brief communications

Single-finger subcutaneous defibrillation lead and "active can": a novel minimally invasive defibrillation configuration for implantable cardioverter-defibrillator implantation in a young child

^a Division of Cardiology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pa, USA
^b Cardiothoracic Surgery, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pa, USA
^c Cardiac Anesthesia, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pa, USA

Received for publication October 29, 2002; revisions received January 6, 2003; revisions received January 10, 2003; accepted for publication February 11, 2003.

^* Address for reprints: Nandini Madan, MD, Heart Center for Children, St Christopher’s Hospital for Children, Erie Avenue and Front Streets, Philadelphia, PA 19134, USA
nandini.madan@tenethealth.com

The first 20% of the full text of this article appears below.

Implantable cardioverter defibrillators (ICDs) provide a safe and effective treatment for life-threatening ventricular arrhythmias. Several investigators have demonstrated that ICD use in pediatric patients is feasible, effective, and associated with a low risk of sudden death in follow-up.¹ However, ICD placement in young children can usually be accomplished only by a thoracotomy approach involving multiple incisions and placement of epicardial defibrillation electrodes. We describe a less invasive yet efficacious lead configuration likely to be associated with a lower complication rate.

Clinical summary

A 3.5-year-old, 17.5-kg, previously healthy boy came to the emergency department of a referring hospital in status epilepticus. He was found to be in ventricular fibrillation, which responded to external defibrillation. He was resuscitated and treated with a lidocaine infusion and phenytoin. He made a full neurologic recovery and was transferred to our institution for further management. There was no family history of cardiac disease. His physical examination, electrocardiography, echocardiography, and cardiac magnetic resonance imaging results were normal. A decision was made to implant an ICD for this episode of aborted sudden death. Because of his age, size, and probable lifelong need for defibrillation, the decision was made to place a single subcutaneous defibrillation lead and "active can" configuration.

In the operating room, with the patient under general anesthesia, the apex of the heart was exposed through a subxiphoid incision. A Medtronic 7841 epicardial . . . [Full Text of this Article]

This article has been cited by other articles:

				C. Schreiber, M. Kostolny, A. Eicken, and R. Lange Nonthoracotomy Cardioverter Defibrillator Implantation in a 2-Year-Old Infant With Long QT Syndrome Ann. Thorac. Surg., June 1, 2006; 81(6): e27 - e28. [Abstract] [Full Text] [PDF]