Related Experiment Video
Updated: Aug 18, 2026
A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Endocardial pacemaker implantation in infants weighing < or = 10 kilograms
Janneke A E Kammeraad1, Eric Rosenthal, Julian Bostock
1Department of Cardiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Insights
Endocardial pacemaker implantation is a feasible and effective alternative to epicardial pacing in small children weighing 10 kg or less. This approach offers an acceptable option for pediatric patients requiring permanent pacing.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Epicardial pacemaker implantation is standard for infants but carries risks.
- Endocardial pacing offers a potential alternative for small children.
Purpose of the Study:
- To review the experience with endocardial permanent pacemaker implantation in children weighing 10 kg or less.
- To evaluate the feasibility, effectiveness, and complications of this approach.
Main Methods:
- Retrospective review of 39 children (<= 10 kg) who underwent endocardial pacing at two centers.
- Analysis of pacing indications, procedural outcomes, and long-term follow-up data.
Main Results:
- Endocardial pacing was successfully implanted in 39 children (median age 3.8 months, weight 4.6 kg).
- Common indications included complete heart block (34 patients).
- Over a median follow-up of 4.3 years, complications included generator replacements (18), lead advancements (12), and lead extractions (10 successful).
Conclusions:
- Endocardial permanent pacing is a feasible and effective option for children weighing 10 kg or less.
- It serves as an acceptable alternative to epicardial pacing in this pediatric population.
Abstract:
Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.
