Extrapleural Intrathoracic Implantation of Permanent Pacemaker in the Pediatric Age Group

Intrathoracic Implantation of a Dual-Chamber Pacemaker in a Preterm Infant with Congenital AV Block

“…The ideal implantation site remains to be determined, particularly in low birth weight infants . Intraperitoneal, retroperitoneal, and preperitoneal approaches have led to complication such as dislocation, intestinal injury, ileus, hernia, sepsis, intraperitoneal migration of leads, and respiratory distress secondary to upper abdominal midline incision . Another disadvantage of the retroperitoneal approach is the decubitus position of the patient, which complicates intervention in case of cardiac arrest during surgery.…”

“…Roubertie et al described complication‐free intradiaphragmatic implantation of a single‐chamber pacemaker in a 1300‐g preterm infant . Agarwal et al implanted extrapleural intrathoracic single‐chamber pacemakers in six patients who had acquired or congenital complete AV block and weighed between 1.8 and 14 kg, with no complications . The advantages of this technique are the sufficiency of a single incision, less cutaneous scarring, additional protection from damage provided by the rib cage, and ease of access to the generator, while the disadvantages are possible extrapleural migration of the device and compromised pulmonary mechanics.…”

“…Looping a portion of the leads and leaving them in a prepared subrectal pocket may allow the generator to be placed there during the next change. Also, we do not worry about the possibility of adhesions at the time of generator replacement because most likely, there will be a well‐defined fibrous capsule and the generator will be easily enucleated as defined by Agarwal et al The larger dual‐chamber generator is more likely to compromise pulmonary mechanics in the early postoperative period than a single‐chamber one. In the case of our patient, however, this may have been related to pulmonary parenchymal damage and ventricular dysfunction caused by RDS.…”

“…Permanent pacemaker generators are implanted subcutaneously or submuscularly on the chest or the abdominal wall. In recent years, new techniques like intradiaphragmatic or extrapleural intrathoracic implantation have emerged …”

Care of the Pediatric Patient with a Device

“…Ventricular tachyarrhythmias due to a completely reversible disorder in the absence of structural heart disease 2006 ; Stephenson et al 2006 ;Agarwal et al 2007 ;Berul 2008 ;Blom 2008 ). In these patients, prior VT or cardiac arrest merits Class I -ICD implantation is indicated for: 1.…”