Transvenous Pacing in Children Weighing Less than 10 Kilograms

Abstract

Pacemakers are used in small children with increasing frequency for the treatment of life-threatening bradyarrhythmias. The epicardial approach is generally preferred in these patients, to avoid the risks of vessel thrombosis. We examined the feasibility and safety of transvenous pacemaker implantation in children weighing <10 kg, via subclavian puncture, using a 4 Fr sheath introduced after a venogram was performed to evaluate the vein diameter. Progressive dilation with 5, 6, and 7 Fr sheaths preceded the insertion and placement of the endocardial lead. A subaponeurotic pocket was created in the abdominal or pectoral regions, depending upon the patient's size. Between 2001 and 2007, we treated 12 patients (median age = 16 months; range 1-32; median weight = 7.9 kg; range 2.3-10.0; 7 males), of whom four weighed <5 kg. Indications for permanent pacing included postsurgical complete atrioventricular block (n = 8), sinus node dysfunction (n = 2), congenital atrioventricular block (n = 1), and long QT syndrome (n = 1). Single-chamber pacemakers were implanted in 10, and dual-chamber pacemakers in two patients. The patients were evaluated at 48 hours, 10 days, and at 3 and 6 months. The mean follow-up was 31.8 +/- 23.5 months. There were no procedural complications. Lead dislodgment occurred in one patient and required replacement of the ventricular lead. One patient died from septicemia. Endocardial pacemaker implantation was feasible and safe in children weighing <10 kg. This procedure is less invasive than the standard epicardial approach.

Lead Extraction in Pediatric and Congenital Heart Disease Patients

“…The increasing availability of pediatric-compatible transvenous devices with reduced diameter leads and smaller size generators as well as the accumulating evidence of their superiority to epicardial systems 19,[25][26][27] have led to an increasing frequency of transvenous device implants in younger pediatric patients. 28,29 In addition, of the ever-growing population of young adults with repaired or palliated CHD, a significant proportion eventually have heart rhythm complications requiring pacemaker or ICD placement. 24,30 -32 These combined patient groups are expected to continue to grow, and a subset will ultimately face the need for lead revision for a variety of reasons.…”

Twenty-Seven Years Experience With Transvenous Pacemaker Implantation in Children Weighing <10 kg

“…4,[12][13][14] Transvenous pacing was, therefore, only practiced in a small number of centers. [6][7][8][9][10][11] To date, ours is the only single-center series of transvenous pacing in children <10 kg with systematic follow-up and is therefore unique in documenting the long-term follow-up over a minimum of 11 years ≤27 years. In older children (mean ages, 5.3±3.9 and 9.2±4.7 years), early-and intermediate-term complication rates after transvenous pacemaker implantation (after a median of 3-8 years) ranged from 14.5% to 24%.…”

“…[3][4][5] Despite the early encouraging results, there has been little in the way of longer term follow-up in the literature. [6][7][8][9][10][11] We now present the only long-term report of this strategy in a consecutive series of patients from a single center followed up for a minimum of 11 years over a 27-year period.…”

Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isolado

“…A taxa de sobrevida média de cinco anos para cabos-eletrodos endocárdicos em crianças variou entre 76% e 89%, enquanto reoperações ou complicações devido a cabos-eletrodos epicárdicos foram observadas em 15% a 20% dos pacientes 12,19,20,[22][23][24]31 . …”

“…Por outro lado, crianças com peso acima de 10 kg têm recebido marca-passos transvenosos. Marca-passos atrioventriculares vem sendo utilizados, usualmente, em adolescentes e adultos jovens [19][20][21] . No presente estudo foi possível observar que estes conceitos foram utilizados no que diz respeito ao modo de estimulação, com idade média de 2,7 ± 2,5 anos para os implantes ventriculares e de 6,0 ± 6,2 para os atrioventriculares.…”