“…3,4 Please see Figure 1 for a timeline of leadless pacemaker implantation in children and access. [1][2][3][4][5][6] Regarding IJ access, the veins are usually large enough in size to fit the 23 F (27 F outer) sheath required for Micra implant, including in the nine patients (eight published) under 30 kg in whom we have employed this technique, with patients as small as 19 kg without additional measures and with more creative measures, such as through an eSheath in smaller patients, such as the 10.9 kg patient. 7,8 Regardless of implant technique, a second sternocleidomastoid mattress suture can also be helpful in assuring proper closure.…”