Percutaneous jugular leadless pacemaker implantation in a pediatric patient

Abstract

Introduction: Leadless cardiac pacing has not been widely utilized in pediatric patients, in part due to concerns regarding size of the delivery sheath and the potential for vascular injury.Methods: We present a case of leadless pacemaker implantation via internal jugular vein without a surgical cutdown.Results: A leadless pacemaker was successfully implanted in the right ventricle via internal jugular approach in a pediatric patient with congenital heart disease. Conclusion:This is a novel approach to leadless pacemaker implantation that could broaden the utilization of this technology to the vulnerable population of children, especially those with congenital heart disease.

Percutaneous leadless pacemaker implants in children

“…Regarding the article by Kumthekar et al, 1 it is great to see other centers also employing a safe and less invasive method and appreciate the publication of this article, which adds to the growing body of literature on the safety of percutaneous IJ implant of pacemakers in children. I think many of us anticipate the leadless platform may be here to stay, and the body of evidence and safety of extraction of coil-based (and even of tine-based) leadless pacemakers will also continue to grow.…”

“…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.…”