Smaller Scars, Fewer Risks: A New Implantable Cardioverter-Defibrillator for Kids

Texas Children’s Hospital recently became one of only a few hospitals in the United States to use a new kind of heart device for children called an extravascular implantable cardioverter-defibrillator (EV-ICD). This device works like a traditional defibrillator by protecting the heart from dangerous rhythms, but it does so in a way that may lower some of the risks children face with older devices.

What is an ICD?

An ICD is a small device that helps protect people who are at risk for life-threatening heart rhythms. If the heart beats too fast or stops suddenly, the ICD can send a quick electrical signal to bring the heartbeat back to normal. These devices are often recommended for children or teens who have certain heart conditions that put them at risk of sudden cardiac arrest.

A traditional ICD is placed under the skin near the collarbone. From there, thin wires called leads are threaded through the veins and attached to the heart. This setup works well but can cause challenges in children because their bodies are still growing. Wires may need to be replaced over time, and because they go through the bloodstream, there is a risk of infection or blood vessel damage.

How the EV-ICD is different

The EV-ICD provides the same lifesaving protection but avoids the veins entirely. Instead, it’s placed under the breastbone through a small opening near the ribcage.

“This treatment should be a detail and not a driver in a patient’s life,” said Taylor Howard, MD, pediatric cardiologist at Texas Children’s. “What we do now should set patients up for success and fewer complications later in life.”

Because the EV-ICD doesn’t touch the bloodstream, it lowers the risk of infection and avoids damage to blood vessels. It also doesn’t require extra wire slack to leave room for growth, something that can lead to issues over time.

What the EV-ICD means for kids and families

For children and teens, there are a few key benefits:

• Same protection: In trials conducted in adults, the EV-ICD successfully detected and treated arrhythmias at rates comparable to traditional ICDs.
• Smaller scar: Instead of a visible scar near the collarbone, the EV-ICD leaves a smaller, less noticeable mark.
• Fewer surgeries: The device has the same battery life as older devices but may delay or even prevent the need for major removal procedures later.
• Lower risk of complications: By avoiding the veins, children are less likely to face infections or blood vessel damage down the road.

The first patient at Texas Children’s to receive the EV-ICD was a 14-year-old with a condition called hypertrophic cardiomyopathy. The family worked closely with doctors and their insurance company to get approval for the procedure. After surgery, the teen was able to return to school and is doing well. While some sports are restricted for medical reasons, the patient has been able to return to normal daily activities.

Before performing the surgery, the care team completed special training with the device manufacturer, Medtronic. This included practice procedures to make sure the team was ready for the first pediatric patient.

Looking ahead

The EV-ICD was approved for adults in 2023 and is now being studied for use in children. Right now, only a few hospitals across the country are offering this option, and Texas Children’s is one of them. Doctors believe it may become a standard choice in the future for young patients who need long-term heart rhythm protection. 

“When we choose a device for a child, we’re thinking about how it will impact them when they’re 40, 60, even 70 years old,” said Dr. Howard. “We have to plan for the long term. The EV-ICD gives us a tool that aligns better with that long-term view.”

Doctors at Texas Children’s may consider the EV-ICD for children who are big enough for a traditional defibrillator, usually at least 30–35 kg (about 70–80 pounds).

What families should know

Having options matters. Every child is unique, and treatment plans should reflect both medical needs and quality of life. The EV-ICD is one more way to provide families with choices that support both health and daily living.

If your child has been told they may need a heart device, talk with your cardiologist about whether an EV-ICD could be an option. To learn more, visit the Texas Children’s Heart Center or ask your doctor about a referral to our team.