Cardiac devices in the pediatric population: an overview of the indications and complications

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Pacemakers, implantable cardioverter-defibrillators, and biventricular pacemakers have similar uses in the pediatric population as they do in the adult population. Pacemaker indications are similar in adults and children: sinus node dysfunction and second or third degree atrioventricular blocks. Pacemaker candidacy in pediatrics, however, must take into account the patient’s symptom burden rather than absolute heart rate cutoffs. Normal ranges for heart rates in children are also different than adults and vary depending on a child’s age. The guidelines for implantable cardioverter-defibrillators likewise are similar to those for adults, being indicated as secondary prevention for sudden cardiac death survivors and as primary prevention in select patients who experience ventricular tachycardia. However, there are currently no specific recommendations for these devices in children with congenital heart defects. Likewise, though there is new promising research, there are currently no specific indications for biventricular pacing in children. The potential complications of pediatric cardiac devices relate to the different heart rate requirements children have compared to adults and the general procedural risks associated with cardiac implants (infection, bleeding, device failure). Despite the recent growth in the use of cardiac devices in children, there is still much room for continued research into the potential indications for and complications from these tools in the pediatric population. Unfortunately, the lack of evidence holds true not only for South America but worldwide. Research studies conducted in South America would give a better understanding about the demographic differences in terms of outcomes.