[SCD-FORUM] 98E RE: ICD implantation in children. Dr. Saul

[SCD Symposium]

Although I do not have any direct experience with a shock coil in the
IVC, there are many techniques described for smaller children,
many of which have utility because the DFT's in children are
generally lower. I think the preference of many peds EP docs in the
smaller child is to avoid the intravascular space completely for at
least the shock coils. Described options include:

- Subcutaneous coils in the back (single lead, array or patch)
- An endocardial coil passed thru the inferior pericardium, around
the heart and screwed in superiorly near the pulmonary veins.
- A patch or coil sewed onto the pleura between lung segments
posterior to the heart.
- Cans placed in the abdominal wall or between the pericardium and
pleura inferiorly.

The bottom line is anything that avoids a shock lead in the RV is
preferred for patients not near adult size, and may even be better for
young patients near adult size due to the issues with long term lead
maintainance.

J. Philip Saul, M.D.
Director, The Children's Heart Program of South Carolina
Physician-in-Chief, MUSC Children's Hospital
Medical University of South Carolina

>
> ICD implantation in children is a major problem. The first problem  
> is the implantation of the ICD lead inside the right ventricle with  
> coil unfitted for the size of the cavity and development of  
> adherences between the coil and the tricuspid valve. In this  
> population we will have to extract these leads during the FU of  
> these patients and in our experience this extraction is challenging  
> even on recent leads. Hence, we have recently used the technique  
> describe by GASPARINI et al (J Cardiovasc Electrophysiol, Vol. 16,  
> pp. 1381-1383) with a coil in the inferior vena-cava. What is your  
> experience with this technique?
>
> Didier Klug, MD, PhD
> Hôpital cardiologique de Lille
> University of Lille
> France

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




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