Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

Abstract

Bradycardia due to high-degree atrioventricular (AV) block remains the main indication for permanent cardiac pacing in childhood. Although there are major differences in the etiology of AV block in children and adults, the same pacing systems and leads are used in both age groups. The first pacemaker was implanted in a child in the late 1960s (Martin et al., 1966). Nowadays, implantation of a permanent pacing system is a straightforward and safe procedure with excellent pacemaker performance during follow-up, even in infants and small children (Welisch et al., 2010). Applying permanent pacing therapy in the young can be challenging. Many paediatric issues, such as patient size, body growth, coexistence of congenital heart disease, presence of residual intracardiac shunts and life style, have to be considered. Selecting the best pacing system for a child requires a firm understanding of modern pacing design, pacing indications, advantages and drawbacks of epicardial and endocardial lead pacing, and possible complications. The aim of this chapter is to give a dedicated overview of the practical implications of pacing in children with complete AV block.