Kriebel Thomas, Ruschewski Wolfgang, Gonzalez y Gonzalez Maria, Walter Katharina, Kroll Johannes, Kampmann Christoph, Heinemann Markus, Schneider Heike, Paul Thomas
Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, FR Germany.
Pacing Clin Electrophysiol. 2006 Dec;29(12):1319-25. doi: 10.1111/j.1540-8159.2006.00542.x.
There is no clear methodology for implantation of an internal cardioverter-defibrillator (ICD) in infants and small children. The aim of this study was to assess efficacy and safety of an extracardiac ICD implantation technique in pediatric patients.
An extracardiac ICD system was implanted in eight patients (age: 0.3-8 years; body weight: 4-29 kg). Under fluoroscopic guidance a defibrillator lead was tunneled subcutaneously starting from the anterior axillar line along the course of the 6th rib until almost reaching the vertebral column. After a partial inferior sternotomy, bipolar steroid-eluting sensing and pacing leads were sutured to the atrial wall (n = 2) and to the anterior wall of the right ventricle (n = 8). The ICD device was implanted as "active can" in the upper abdomen. Sensing, pacing, and defibrillation thresholds (DFTs) as well as impedances were verified intraoperatively and 3 months later, respectively.
In seven of eight patients, intraoperative DFT between subcutaneous lead and device was <15 J. In the eighth patient ICD implantation was technically not feasible due to a DFT >20 J. During follow-up (mean 14.5 months) appropriate and effective ICD discharges were noted in two patients. DFT remained stable after 3 months in four of six patients retested. A revision was required in one patient due to lead migration and in another patient due to a lead break.
In infants and small children, extracardiac ICD implantation was technically feasible. Experience and follow-up are still limited. The course of the DFT is unknown, facing further growth of the patients.
对于婴幼儿植入体内除颤器（ICD），尚无明确的方法。本研究的目的是评估小儿心外膜ICD植入技术的有效性和安全性。
对8例患者（年龄：0.3 - 8岁；体重：4 - 29 kg）植入心外膜ICD系统。在荧光透视引导下，将除颤器导线从腋前线沿第6肋皮下隧道至几乎到达脊柱。部分胸骨下段切开术后，将双极类固醇洗脱感知和起搏导线缝合至心房壁（n = 2）和右心室前壁（n = 8）。ICD装置以“主动罐”形式植入上腹部。术中及3个月后分别验证感知、起搏和除颤阈值（DFT）以及阻抗。
8例患者中有7例，皮下导线与装置之间的术中DFT<15 J。第8例患者因DFT>20 J，ICD植入在技术上不可行。随访期间（平均14.5个月），2例患者记录到适当且有效的ICD放电。再次测试的6例患者中有4例在3个月后DFT保持稳定。1例患者因导线移位需要进行翻修，另1例患者因导线断裂需要翻修。
对于婴幼儿，心外膜ICD植入在技术上是可行的。经验和随访仍然有限。面对患者的进一步生长，DFT的变化过程尚不清楚。
