Twenty years experience with pediatric pacing: epicardial and transvenous stimulation

Abstract

Transvenous pacing in the pediatric population is associated with a lower acute stimulation threshold and a lower rate of lead-related complications. If epicardial pacing is necessary (e. g. small body weight, special intracardiac anatomy (e.g. Fontan), impossible access to superior caval vein), steroid-eluting leads may be considered.

Permanent complete heart block following surgical correction of congenital heart disease

“…Their use has been shown to give success rates and generator longevity comparable to transvenous electrodes. 19 Parental concern regarding the need for repeated pulse generator replacements is one of the key morbidity issues found in this study. The primary factors here are both economic and procedural.…”

“…Rising chronic thresholds ultimately lead to the phenomenon of exit block in such epicardial systems. In less severe cases, the battery longevity is compromised 19 . In small children, small upper chest vein size may preclude a transvenous implantation technique.…”

Surgical Placement of Permanent Pacemaker Following Temporary Trasvenous Pacemaker in a Child with Congenital Heart Block and Moderate Size PDA: A Case Report

“…13,14 In neonates and infants with a permanent pacemakerthe occurrence of episodes of loss of consciousnessmay be due to pacemaker malfunction. 15 Follow-upchecks should be performed every 6 months inthose without symptoms; parameters of pacemakerfunction should be measured, mainly the resistanceand threshold of the atrial and ventricular leads. Ifsymptoms occur as a result of pacemaker malfunction,24-hour Holter monitoring is useful for their detection.…”

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

“…Although, the epicardial approach remains essential in children with congenital heart disease in whom venous access is not available, a transvenous lead system is most commonly advocated in children of adequate size (Fortescue et al, 2004;Kammeraad et al, 2004). An endocardial pacing system is preferably implanted in children weighing more than 15 kg (Fortescue et al, 2004;Alexander 2004), although implantation at a smaller patient size has been reported (Kammeraad et al, 2004;Sachweh et al, 2000). Several patient and lead related features should be weighed before an optimal decision regarding an epicardial or endocardial lead system can be made.…”