Nontransvenous implantable cardioverter defibrillator systems: not just for small pediatric patients.

摘要

In a small but increasing number of patients, a standard transvenous implantable cardio-defibrillator (ICD) system cannot or should not be implanted. The list includes pediatric patients who are small and in whom either a transvenous system technically can not be performed or in whom repeated extraction/implantation of future systems may carry undue risk associated with those procedures or may leave no venous access if extraction is not successful. The growing number of successfully operated, surviving congenital heart disease (CHD) patients provides numerous pediatric as well as adult patients in whom an ICD is indicated. However, many of these patients have issues that potentially increase the risk of a transvenous system including an intracardiac right to left shunt. Also, there are adult non-CHD patients in whom the standard transvenous approach is not possible due to venous access problems, ineffective transvenous systems (e.g., unacceptably high defibrillation thresholds), or it is contraindicated (e.g., infectious/thrombotic disease).Cardioverter-defibrillator implantation in pediatric patients in the early and mid-1980s followed the initial use of epicardial patch systems in adults but was restricted to older, bigger children, and adolescents due to the large generator device.