Pacemaker therapy: the newborn and the nonagenarian

Abstract

This editorial refers to ‘Long-term outcome of cardiac pacing in octogenarians and nonagenarians’ by E. O. Udo et al ., on page 502 and ‘Permanent epicardial pacing in children: long-term results and factors modifying outcome’ by P. Kubus et al ., on page 509 The average age of patients with an indication for pacing is ∼75 years at the time of implantation. However, permanent pacemaker therapy can be necessary at all ages, from newborn to the nonagenarian. Particularly in these age groups, age matters: in small children, there are technical and anatomical considerations that render pacemaker implantation difficult; in very old patients, their relatives, in particular, but also physicians may have concerns about pacemaker implantation that is perceived as too invasive for such an old patient with significant comorbidity. Two publications in this issue of the journal address pacemaker therapy in these two age groups.1,2 Pacemaker therapy in children faces several challenges. Transvenous implantation may not be feasible due to lack of venous access to cardiac cavities, or may be difficult due to the small venous diameter that either prevents lead introduction or—if the lead can be introduced—obliterates soon after implantation. Lead dysfunction (lead fracture, exit block, and sensing failure) during growth can occur despite formation of loops of the lead at the time of implant. Therefore, epicardial pacing remains the preferred mode of implantation in small children. As an advantage, the epicardial approach allows dual-chamber pacing earlier than transvenous implantation and left ventricular pacing to prevent adverse haemodynamic long-term consequences of right ventricular pacing. Even though pacing is increasingly applied in paediatric patients, only few long-term data are available …