Subcutaneous finger cardioverter-defibrillator in low weight paediatric patients: a case series

Placement of traditional transvenous implantable cardioverter defibrillator (ICD) system in low-weight children is often difficult because of their vessel size, the elevated risk of lead malfunction and failure, children's growth and various anatomic constraints, cre-ating the need for alternative solutions. Subcutaneous array leads combined with an abdominally placed ICD device can minimize the surgical approach. In this case series, we analyse the data behind indications for subcutaneous finger cardioverter defibrillator (SFCD) and discuss the preliminary clinical experience in low -weight children. We considered 4 consecutive children (mean age 3.9 years, range 3-5.5 years, mean body weight 17.6 kg, range 14-23 kg) who underwent SFCD implant from April 2016 to August 2020. All patients showed a good compliance to the device system with no complications (infections or skin erosions). No patients experienced in the observation period (mean time 44.5 +/- 21.5 months) sustained ventricular arrhythmias requiring shocks. No inappropriate shocks released by the device occurred. No significant changes were observed in LET (lowest energy tested) performed around 24 months of follow-up. All patients showed a good compli-ance and stable atrio-ventricular sensing and pacing thresholds. In smaller children in whom a transvenous approach is not feasible or not possible for anatomic reasons, the SFCD appears to be a safe method to prevent SCD with little surgical trauma and preservation of an intact vascular system, providing an adequate bridge to trans -venous ICD or subcutaneous ICD implant late in the life.

Automated summary

Placement of traditional transvenous ICD system in low-weight children is challenging due to vessel size and other anatomical constraints. Subcutaneous array leads combined with an abdominally placed ICD device are a potential alternative with minimal surgical trauma. This case series presents successful implantation of SFCD in low-weight children, showing good compliance and no complications or sustained ventricular arrhythmias requiring shocks.