Pacing in small infants

Pacing in small infants

Issues on transvenous pacing in small infants

Important concerns in transvenous pacing pacing in small infants are venous thrombosis due to the small veins and growth issues producing lead stretch, redundancy and displacement when an extra loop is kept, and infections. Paradoxical embolism is possibility in those with right to left shunts. Endocardial leads are better avoided in such situations. Ultrasound follow up is obtained at least once in two years to check for venous thrombosis. A venographic study showed 25% incidence of venous obstruction of which 13% was complete and 12% partial.

Limitations of epicardial approach for pacing in small infants

Higher failure rates, unipolar leads, poor battery life due to high chronic thresholds or low impedance. Lead survival is lesser for epicardial approach. Bipolar leads have lesser energy drainage.

Factors in favour of epicardial pacing in small children

Epicardial pacing can be done through a mini lateral thoracotomy. Left ventricular apical pacing is thought to be better than right ventricular apical pacing in terms of left ventricular ejection fraction. The need for lead extraction is delayed in epicardial pacing. Button leads are better than screw in leads for epicardial pacing. Steroid eluting button leads have good performance. Smaller children can go for epicardial pacing and later on when revision is required, for transvenous pacing.