Use of a single coil transvenous electrode with an abdominally placed implantable cardioverter defibrillator in children

While transvenous defibrillator electrode placement avoiding a thoracotomy is preferable, electrode size, a large intercoil spacing, and the need for subclavicular device placement preclude this approach in most children. We investigated a single RV coil to an abdominally placed active can ICD devic e. Five children ages 8-16 years (weight 21-50 kg, mean 35 kg) underwent IC D placement. Placement of a single coil Medtronic model 6932 or 6943 electr ode was performed via the left subclavian vein approach and the electrode p ositioned in the RV apex with the coil lying along the RV diaphragmatic sur face. The ICD (Medtronic Micro Jewel II model 7223Cx) was implanted in a le ft abdominal pocket with the lead tunneled from the infraclavicular region to the pocket. Implant DFTs were less than or equal to 15 J using a biphasi c waveform. DFTs rechecked within 3-month postimplant were unchanged. Lead impedance at implant ranged from 38 to 56 Omega, mean 51 Omega. Follow-up w ets 3-21 months (total 82 months) with no electrode dislodgment, lead fract ures, or inappropriate discharges. Two of the five patients have hard succe ssful appropriate ICD discharges. Transvenous ICD electrode placement can b e performed in children as small as 20 kg with the device implanted in a co smetically acceptable abdominal pocket that is well tolerated. Excellent DF Ts can be achieved. This approach avoids a thoracotomy in all but the small est child, does not require subclavicular placement of the device, and avoi ds use of a second intravascular coil.