Retrosternal Implantation of the Cardioverter-Defibrillator Lead in an Infant.

Using an implantable cardioverter-defibrillator (ICD) in small children is still challenging, but the need is increasing. We present a new approach to overcoming ICD problems caused by growth in infants. A redundant ICD lead was fixed to the superior border of the sternum and tunneled retrosternally to the subxiphoid region for connection to the generator, which was placed in a pocket beneath the left transversus abdominis muscle. The redundant retrosternal part of the lead straightened during growth, while cardiac coverage by the cardioversion energy field and the defibrillation vector were maintained appropriately.