Cardiac pacing in infants and children

Pacemakers have been implanted in pediatric patients since the late 1960s. Indications for cardiac pacing in infants and children have evolved to include controlling symptoms as well as providing a life-sustaining cardiac rhythm. Pacemakers have become smaller and able to perform more complex functions. Current pacemakers offer a variety of operation modes, which are chosen on the basis of the pacing indication or the potential hemodynamic benefit. Today's pacemakers have the ability to maintain AV synchrony, perform rate-responsive pacing, and sometimes prevent or treat tachyarrhythmias. Recent advances in pacing lead technology, such as steroid elution, have narrowed the gap between epicardial and endocardial leads in terms of chronic pacing thresholds and sensing characteristics. The choice of a permanent pacing system is determined by the patient's size, underlying arrhythmia, and the anatomic details of any structural heart disease. Selection of temporary pacing modalities depends on the urgency of initiating pacing and the anticipated duration of temporary pacing. The decision to implant a permanent pacemaker in a pediatric patient commits the patient to long-term follow-up of pacemaker function. Such follow-up is important to ensure adequate safety margins for pacing and sensing, anticipate the need for pacemaker replacement, screen for pacemaker malfunctions, and optimize programmable settings. Pediatric cardiac pacing has evolved into its own subspecialty over the past decade. As more infants with complex congenital heart disease are being successfully treated with surgical palliation and repair, the population of pediatric patients with permanent pacemakers is likely to increase.