Leadless Pacemaker Implantation in a Four-year-old, 16-kg Child

Abstract

Leadless pacemakers have an accepted role with demonstrable benefits in adults. In contrast, implant experience and follow-up data in pediatric patients are more limited. Clinical indications and patient candidacy for leadless pacing in pediatrics continue to evolve. We present our experience implanting a leadless pacemaker in a four-year-old for the treatment of high-grade atrioventricular block. Implant considerations in small patients, short-term patient and device follow-up data, and follow-up assessment of the vessel used for implantation are discussed.

The Year in Pediatric Electrophysiology: 2021

“…7 This hybrid approach, with their systematic approach to vessel assessment with preprocedural ultrasound imaging nicely described in the article, is contrasted with the femoral vein approach, which has been used in patients as small as 16 kg. 8 It has been suggested that a minimum vessel diameter of 9 mm is required for the 27-French (Fr) delivery sheath, though the distensibility of the femoral vasculature has been demonstrated by proponents of the traditional femoral approach in even the smallest patients (Figure 1).…”

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.…”

“…In this particular case, leadless pacing was considered a firstline treatment option in an individual without contraindications to traditional transvenous or epicardial implant approaches. Previous publications [8][9][10][11][12][13] have cited limitations to conventional implants due to patient-related circumstances or medical complexities, thereby driving the decision to pursue leadless pacing as a secondary option.…”

“…Femoral and internal jugular venous approaches have been used during pediatric Micra™ implantation with excellent implant success rates and good postimplant device stability and function. Though our collective experience is still fairly limited, published cases [8][9][10][11][12][13] have demonstrated successful and functional leadless pacing from the right ventricle (RV) in pediatric patients across a broad spectrum of sizes. Perhaps the foremost question in pediatric implants is whether the leadless pacemaker is too large to go through the lower vasculature.…”

Percutaneous jugular leadless pacemaker implantation in a pediatric patient

“…Leadless pacemakers pose an interesting and novel solution for many pediatric patients. However, other than a handful of case reports and case series' the majority of cases have been performed in adults 2,3,6–9 . A major disadvantage of the leadless pacing approach is the large size of the delivery sheath (27‐French outer diameter), which can be prohibitive in small patients.…”