Inferior vena cava loop of the implantable cardioverter defibrillator endocardial lead: A possible solution to the growth problem in pediatric implantation

The ICD is an important treatment option in adults and children with life-t hreatening tachyarrhythmias. The possibility of lead displacement caused by growth and the lack of dedicated leads and devices poses special problems in pediatric ICD implantation. We describe our experience in three children in whom we left a redundant lead loop within the inferior vena cava (IVC) to allow for further growth. Since February 1998, three children underwent ICD implantation at our institution. A lead (screw-in) wets advanced into t he right ventricular apex, and a loop was created in the IVC by progressive ly withdrawing the styler and pushing in the lead. Satisfactory sensing and pacing threshold values were obtained and a successful single 16-J defibri llation rest was performed. No complications were encountered. After a mean follow-up of 16 months, with a mean increase in body weight and height of 4.1 +/- 0.5 Kg and 6.3 +/- 0.4 cm, respectively, chest X ray showed some re lease of additional lead length, in the absence of dislodgments, while sign ificant changes in pacing/sensing parameters were not found. In conclusion, the creation of a loop within the IVC allows the lead to adjust for growth in children receiving an ICD. This approach is feasible and safe.