New approach to implantable cardioverter-defibrillators in small pediatric patients: Dorsal positioning of superior vena cava shock lead in a 3-year-old

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The use of implantable cardioverter-defibrillators (ICDs) in pediatric patients is increasing, and the average age at implantation is decreasing.1 Because the constraints of vascular and thoracic anatomy necessitate the adaptation of existing systems, which were developed for and tested in adults,2 ICD implantation in pediatric patients remains a challenging procedure. Device-related complications occur in more than 10% of the pediatric ICD recipient population,3 and the effectiveness of shock therapy varies,4 emphasizing the importance of optimal lead and device positioning in such patients.