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Placement of a permanent epicardial pacemaker in children using a subcostal approach
K G Warner1, D P Halpin, C I Berul
1Division of Cardiothoracic Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA. kenneth.warner@es.nemc.org
Background:
Previously described techniques for epicardial pacemakers in children have generally included either a left thoracotomy approach or a subxiphoid incision.
Methods:
We have recently used a single left subcostal incision for placement of both the epicardial electrodes and the pacemaker generator. We report our initial experience with this technique in 8 patients. The mean age was 4 years (range, 4 months to 12 years). The smallest patient weighed 4,100 g.
Results:
The subcostal approach was successful in 7 patients. One patient with a narrow costal margin operated on early in our experience required conversion to a thoracotomy. The pacing thresholds were uniformly excellent in all patients. There have been no associated complications.
Conclusions:
Placement of epicardial leads using a left subcostal incision avoids a thoracotomy, is simpler than a subxiphoid approach, and results in acceptable thresholds with minimal morbidity.
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