Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease

Abstract

As intuitive as it might appear, it must be remembered that children are not little adults and congenital heart defects do not equate to normal cardiac anatomy. In addition, repaired congenital heart defects in adults (ACHD) might also not equate to normal anatomy. In each of these clinical situations, pacemaker device therapy may dramatically differ from most of the published information available in the field of internal medicine cardiology. Since there are now more patients with structural congenital heart defects over than under the age of 21 years, all present and future generations of pacemaker implanters need to recognize the plethora of anatomical and structural nuances potentially associated with the implantation of device therapy in this continually expanding patient population. Fortunately, advances in pacemaker and lead technology over the past 20 years, which now permit precise implantation at selective endocardial sites other than the right ventricular apex or atrial appendage and improved epicardial leads, have greatly facilitated optimization of pacing therapy. Whereas past interests have focused on lead performance issues such as dislodgement, fractures, and exit block, improvements in lead design technologies now permit more interest in maintaining or improving paced myocardial function by optimizing lead placement at alternate or more select sites. This article reviews recent applications and future directions of these pacing technologies and emphasizes differences among patients with congenital heart defects.

Cardiac pacing in infants and children

“…Often it is transient and most patients who are going to recover will do so within 10 days 4. Unpaced, postoperative heart block carries a high mortality and common practice is to implant a permanent pacemaker if it has not recovered within 10 days 4 5. However, heart block may recover after pacemaker implant, sometimes years later 4 .…”

“…However, heart block may recover after pacemaker implant, sometimes years later 4 . w6 w7 The decision regarding the type of pacemaker and lead depends not only on patient size but also on cardiac and venous anatomy 5 . w8 …”

Implantable cardioverter defibrillator therapy in paediatric practice: a single-centre UK experience with focus on subcutaneous defibrillation

“…Many papers consider the difficulties of pacing in children. 10,17 Many of these difficulties apply to pediatric ICD usage with additional risks related to appropriate placement of endocardial coils in the paediatric heart. Thus, the transvenous approach in children shares similar risks to that with adults; pneumothorax, endocarditis risk, and thromboembolic phenomena.…”

Congenital heart disease in children and adults Outcomes of long-term endocavitary cardiac pacing in children

“…Technical problems may arise when the weight of the child is very low or if the child underwent surgical congenital heart defect repair. The majority of congenital heart defect repair procedures are performed via the right atrium and the tricuspid valve, which is the reason for the presence of scarring in the atrial region; the auricle of the right ventricle is often excised [18]. In the study group, such children were implanted with atrial electrodes with active fixation.…”