Gasparini Maurizio, Regoli François, Galimberti Paola, Priori Silvia G
Electrophysiology and Pacing Unit, IRRCS, Istituto Clinico Humanitas, Rozzano, Milano, Italy.
J Cardiovasc Electrophysiol. 2005 Dec;16(12):1381-3. doi: 10.1111/j.1540-8167.2005.00228.x.
Experience in endovascular/endocardial techniques for implanting implantable cardioverter defibrillators in early childhood is limited. Potentially, this type of approach could limit the surgical risk, while increasing ICD therapy efficacy. The safety and feasibility of adopting a complete endovascular/endocardial approach for implanting ICDs is assessed by considering the cases of two young children.
Two boys, aged 3 and 6 years, were implanted with ICD for a history of syncope and documented ventricular tachycardia (VT). A complete endovascular/endocardial approach was adopted consisting of positioning a bipolar pacing and sensing lead in the right ventricular (RV) apex with intravascular redundancy forming a loop in the inferior vena cava (IVC), and a caval coil placed in the IVC. Sensing values (7-8 mV), pacing threshold (0.5-0.6 V/0.5 msec), and defibrillation testing (case 1 = 10 J, case 2 = 20 J) were all acceptable. During follow-up, in both cases ICD intervened correctly. In one case, 16 months after implantation, because of change in the IVC coil-active can vector, the IVC coil was effectively repositioned to a more distal position.
A complete endovascular/endocardial ICD implantation technique in early childhood is both feasible and safe. This approach avoids thoracotomy and ensures ICD therapy efficacy.
幼儿植入植入式心脏复律除颤器（ICD）的血管内/心内膜技术经验有限。这种方法可能会降低手术风险，同时提高ICD治疗效果。通过对两名幼儿病例的分析，评估采用完全血管内/心内膜方法植入ICD的安全性和可行性。
两名男孩，年龄分别为3岁和6岁，因晕厥病史和记录到的室性心动过速（VT）植入ICD。采用完全血管内/心内膜方法，将双极起搏和感知电极置于右心室（RV）心尖，血管内多余部分在下腔静脉（IVC）形成一个环，并在下腔静脉放置一个腔静脉线圈。感知值（7-8 mV）、起搏阈值（0.5-0.6 V/0.5毫秒）和除颤测试（病例1 = 10 J，病例2 = 20 J）均可接受。随访期间，两例ICD均正确干预。其中一例在植入16个月后，由于下腔静脉线圈-主动罐向量的改变，下腔静脉线圈被有效地重新定位到更远端的位置。
幼儿完全血管内/心内膜ICD植入技术既可行又安全。这种方法避免了开胸手术，并确保了ICD治疗效果。
