An innovative procedure recently pioneered in Peoria could offer a minimally-invasive path for treating heart arrhythmias in children.
The team implanted a new type of defibrillator in a 2-year-old boy with a genetic heart defect. It's called an extravascular implantable cardioverter-defibrillator, or EV-ICD for short.
"It has the advantage of not having to be implanted within the blood vessels going down to the heart. It can actually be implanted outside of the blood vessels," said Dr. Harma Turbendian, a pediatric cardiac surgeon at OSF Children's Hospital of Illinois.
The device monitors the heartbeat. If it wavers, the defibrillator shocks the heart back into a regular rhythm, preventing cardiac arrest. The EV-ICD was previously only used in teenagers and adults.
The 2-year-old's parents performed CPR and brought their child to the hospital after he went into cardiac arrest. He was diagnosed with Brugada syndrome, a malignant condition that affects about 1 in every 50,000 people.
"It has catastrophic consequences, because people often die in their sleep, and the first presentation could be a cardiac arrest," said Dr. Sunita Ferns, director of pediatric and adult congenital electrophysiology at the Children's Hospital of Illinois.
Ferns called in a team of specialists, and the decision was made to implant the EV-ICD. The device has been used in teenagers and adults before, but never in a child this young, Ferns said.
The procedure was successful. Ferns said the boy will always need an ICD, and it will require a battery change every decade or so, but he can otherwise live a normal life.
"I expect him to be able to live like any normal toddler, growing up and doing all the things little kids do," she said. "But certainly, having a timely diagnosis, having a protective mechanism to prevent him from a life threatening arrhythmia, that is key."
The procedure is also a proof of concept that an EV-ICD is a viable and less invasive option for young kids.
"The options were limited in the past for treating these malignant rhythm issues in smaller children, and the solutions to that were a device. That were much larger and required more extensive operations," said Dr. Mark Plunkett, chief of pediatric and congenital heart surgery at the Children's Hospital of Illinois.
"It's now become essentially a pediatric device as well, and will save countless children's lives in the future," added Turbendian.
Ferns said the procedure also doesn't require a complex cardiac surgical team to implant.
"In many parts of the world, that's not readily available, and so application of this minimally invasive procedure to a child this small has huge implications in, say, third world countries where children might have to travel hundreds or even thousands of miles to get access to a pediatric cardiac surgeon," she said.
The results of the surgery will be published in the Annals of Thoracic Surgery.
