Less invasive procedure for fitting heart devices in children

29th June 2016

 

Doctors in America say that an alternative way of fitting children and young people with internal defibrillators (ICDs) is effective.

They say that fitting the device in the membrane sac around the heart, usually via a small incision in the side of the chest between the ribs, is less invasive.   And it is particularly suitable in young children and those worried about scarring from the wound.

This procedure is called epicardial ICD placement.  It differs from the usual method which sees the device fitted into the front chest wall with leads going into the heart.

The research team, from the Mayo Clinic in Minnesota and led by Dr Andrew Schmeider, said that young patients tended to have higher rates of ICD lead fracture and were more at risk of other related problems.

But fitting the ICD in the inner layer of the heart sac had the potential to avoid the usual complications.  But previous data was very limited, the researchers said.

So they looked at the electronic medical records of all 46 young people having the epicardial ICD placement at the Mayo Clinic from January 2011 to December 2015.

Their ages ranged from under one to 18 with a mean age of ten.  Just under half were girls. Six in ten had the device implanted with a mini-thoracotomy, a small incision in the side of the chest.

During follow-up of up to 4.5 years, surgical complications occurred in seven young people and device related complications in six.  Fifty-eight appropriate shocks were given to seven young people. Four patients received inappropriate shocks due to issues with the leads. One young person with long QT syndrome died from severe low blood sugar levels.

The researchers concluded that epicardial placement was an acceptable alternative to the traditional transvenous placement.

For more details, see here.