Background: The pacemaker lead placement is presented as one of the most appropriate procedures in children with a complete atrioventricular block (AVB). Despite the fact that video-assisted thoracic surgery (VATS) for epicardial lead placement has demonstrated positive results as to the feasibility, safety, and efficacy in adults, its role in pacemaker implantation in children remains unclear. Aim: This study sought to assess the intermediate-term outcomes of video-assisted thoracoscopic pacemaker lead placement in children with complete AVB Materials and Methods: From May 2017 to November 2019, five children with complete AVB underwent minimally invasive left ventricular (LV) lead placements via thoracoscopic video assistance approach. The procedure was performed under complex intratracheal anesthesia with single-lung ventilation, all pacing parameters were evaluated in perioperative and follow-up periods. Results: The median age of children at implantation was 3 years (range: 2 to 4 years), the median weight was 13 kg (range: 12–15 kg). All procedures were completed successfully, pacing thresholds for the active lead measured 0.3-1.1V, with R-wave amplitude of 8-18 mV and impedance of 560-1478 Ohm. Conclusion: Thoracoscopic pacemaker lead placement may provide a potential alternative to the transthoracic approach of epicardial lead placement in children with AVB.

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Carbamazepine is an anticonvulsant that is commonly used in neurological and psychiatric patients to treat epileptic seizures, neuropathic pain, or bipolar disorder. Carbamazepine side effects, as well as side effects of many antiepileptic drugs, include cardiotoxic effects such as atrioventricular block, bradycardia, and cardiac rhythm disorders. However, carbamazepine has also been reported to have antiarrhythmic, normotimic, and membrane-stabilizing effects. This results in its administration to treat arrhythmias in children. Based on literature, carbamazepine administration as anti-arrhythmic drug is known in cases where the basic therapy was ineffective. The medication is not registered anywhere in the world for this purpose. Thus, it can be administered only off-label. The aim of our literature review is to analyze and summarize the existing data on carbamazepine effects on cardiovascular system, to determine its safety as anti-arrhythmic drug, and to describe various factors fostering its side effects.