Implantation of a leadless pacemaker in a pediatric patient with congenital heart disease

Abstract

Patients with congenital heart disease (CHD) and significant postoperative atrioventricular (AV) nodal injury frequently require lifelong backup pacing. However, lifelong pacing in this population is complicated primarily by lead-related issues. Pacing leads in pediatric patients with CHD fail earlier and at higher rates than leads in adults with structurally normal hearts for both epicardial and endocardial leads.1 Somatic growth and the vigorous activity of pediatric patients lead to higher rates of fracture and dislodgment. Surgical repair requiring exogenous materials, including bioprosthetic valves and patches, places transvenous pacing leads in patients with CHD at higher risk for infection; this necessitates extraction procedures for lead removal, which carry up to 2% risk of serious complications, including death.2, 3 Transvenous leads carry significant risk of venous thrombosis and occlusion over the life of pediatric patients and thus have a profound effect in CHD patients who may require frequent venous access for interventional cardiac catheterization procedures, including balloon angioplasty of pulmonary arteries (PAs) and transcatheter pulmonary valve implantation. For these reasons, leadless pacing can be a valuable intervention to minimize the lifelong complications of epicardial or transvenous pacing in pediatric patients with CHD.