Abstract
The debate of when, where, and most importantly, how to permanently pace the heart of a small child is ongoing. In most surgeons’ opinion, an epi(myo-)cardial approach is preferable, although the individual access (ie, subxiphoid, sternotomy, lateral) may vary. Major concerns regarding unsatisfactory stimulation thresholds and significant morbidity are continually being discussed throughout the pediatric community. On the other hand, resultant endeavors to gain transvenous access to rapidly growing hearts have led to raised eyebrows of pediatric cardiac surgeons.
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