Leadless Pacemaker Implantation in a Pediatric Patient with Prolonged Sinus Pauses

Abstract

Permanent cardiac pacing is the only effective solution for patients with symptomatic bradycardia and heart block. About 10% of patients undergoing implantation of the conventional pacing system develop complications related to the subcutaneous pocket or the leads and in pediatric patients lead problems may rise in up to 30% of the patients. The leadless pacemaker devices were developed in order to minimize some of those complications. We present a case of an 11-year-old patient who presented after the sudden death of his older brother, with recurrent episodes of syncope and documented prolonged sinus pauses. The patient underwent percutaneous implantation of a leadless Micra™ pacemaker device with optimal results.

Etiology and device therapy in complete atrioventricular block in pediatric and young adult population: Contemporary review and new perspectives

“…However, prospective RCTs are urgently needed to confirm the long-term safety and effectiveness of this pacing strategy. LP strategy is a valuable alternative, even in pediatric patients, 110 to avoid the deployment of conventional pacing leads with the intrinsic risk of infection, breaking or migration of the lead over decades, as well as providing cosmetic advantages, relevant especially for female patients. Moreover, ingrown fibrotic and calcified PM leads, placed in the venous system for decades, may result more difficult to extract and LP represent a valid alternative in case of recurrent pacing system infection.…”

Expanding the Reach of Pediatric Transcatheter Pacing

“…2,3 Despite these drawbacks, leadless TPSs have been used in carefully selected pediatric patients, often motivated by limited venous access, risk factors for endovascular infection, and/or anticipated time-limited pacing need. [4][5][6][7][8][9] In this issue of The Journal of Innovations in Cardiac Rhythm Management, Hackett et al report the implantation of a Micra™ VR TPS in a 28 kg, nine-yearold patient by surgical cutdown of the right internal jugular vein.…”

“…3 Presently, two devices and implant platforms have been developed, both with the capacity for device delivery into the pericardial space, that show promising early results in animal models. [4][5][6] However, human trials with short-, mid-, and long-term follow-up data are lacking and device availability and high technical implant skill level are far from being widespread.…”

Leadless Pacemakers

“…The idea that this miniaturized pacemaker might be appropriate in smaller patients has been explored in a few case studies. The literature reports a successful implantation of a leadless device (Micra™) in an 11-year-old patient with recurrent syncopal episodes and prolonged sinus pauses [59]. A 71-year-old man with achondroplastic dwarfism had a transvenous pacemaker for decades for third-degree AV block; in 2010, a pocket infection with endocarditis of the tricuspid valve necessitated the extraction of the conventional pacemaker and placement of an epicardial dual-chamber pacemaker with tunneling of leads.…”