Endocardial Pacemaker Implantation in Infants Weighing ≤ 10 Kilograms

Abstract

Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.

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

“…Also the programmability of many pulse generators has seen major advances. Due to these advances, pacemaker therapy can be applied safely to small infants and even preterm infants weighing less than 2000 g (Ohmi et al, 1992;Kammeraad et al 2004,;Inoue et al, 2005). Although most of these infants will receive a single chamber device (VVI mode) with an epicardial pacing lead because of their small size, single lead endocardial pacing systems also have been successfully implanted with an abdominally located pacemaker pocket (Hoorntje et al, 2000).…”

“…Moreover, a dual chamber device can be implanted more easily in small children with or without congenital heart disease using the epicardial approach. Transvenous pacing systems offer the advantages of avoidance of a surgical procedure (thoracotomy or sternotomy), excellent lead survival, and lower acute and chronic pacing thresholds, and thereby increased battery longevity (Kammeraad et al, 2004;Udink ten Cate et al, 2002).…”

“…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.…”

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.…”