Author + information
- Received October 6, 2016
- Revision received March 5, 2018
- Accepted March 15, 2018
- Published online May 2, 2018.
- Thomas Kriebel, MDa,∗ (, )
- Matthias J. Müller, MDa,
- Wolfgang Ruschewski, MDb,
- Ulrich Krause, MDa,
- Thomas Paul, MDa and
- Heike Schneider, MDa
- aDepartment of Pediatric Cardiology and Intensive Care Medicine, George August University Medical Center, Göttingen, Germany
- bDepartment of Thoracic and Cardiovascular Surgery, Georg August University Medical Center, Göttingen, Germany
- ↵∗Address for correspondence:
Dr. Thomas Kriebel, Chefarzt der Klinik für Kinder- und Jugendmedizin und Kinderkardiologie, Westpfalz-Klinikum Kaiserslautern, Hellmut-Hartert-Strasse 1,67655 Kaiserslautern, Germany.
Objective The purpose of this study was to analyze course of defibrillation threshold (DFT) with growth.
Background Data on regular DFT testing after extracardiac implantable cardioverter defibrillator (ICD) placement in infants and small children is still limited.
Methods An extracardiac ICD was placed in 23 pediatric patients (median age 6.1 years; median body weight 21 kg, median length 120 cm). The defibrillator lead was tunneled pleurally, and the device was placed as “active can” in the right upper abdomen or in a horizontal position between the diaphragm and the pericardium, respectively. DFT was verified intraoperatively, 3 months later, and every 12 months thereafter. The aim was to achieve DFT <15 J allowing ICD programming with a double safety margin above DFT.
Results In all 23 patients, an intraoperative DFT <15 J could be accomplished. Serial DFT testing showed an increase from a median DFT of 10 J intraoperatively to 15 J after 1 year. During mean follow-up of 2.0 years, a significant correlation between DFT and body length, but not body weight, was observed. In 4 of 23 (17%) patients, surgical revision was required because of a DFT increase >20 J during regular DFT testing. No complications regarding DFT testing were noted.
Conclusions After extracardiac ICD placement in infants and small children, DFT increase related to body length was evident during mid-term follow-up. Routine serial DFT testing was a safe procedure and identified a significant DFT increase in 4 of 23 patients. Serial DFT testing during follow-up in these patients is recommended.
- infants and children
- implantable cardioverter defibrillator
- extracardiac technique
- defibrillation threshold
- pleural shock elect
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest that they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received October 6, 2016.
- Revision received March 5, 2018.
- Accepted March 15, 2018.
- 2018 American College of Cardiology Foundation
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