The subpectoral pocket: the preferred implant site for pediatric pacemakers

Implantation technique for pediatric pacemaking has evolved from predominantly epicardial to predominantly endocardial. One of the potential problems with endocardial pacing in children is their very thin subcutaneous tissue, which can result in an unpleasant cosmetic result. The superficialness of the pacemaker pulse generator also may render it more susceptible to erosion and infection. A series is presented of pediatric patients who underwent implantation of a transvenous bipolar pacing system in the pediatric catheterization laboratory. The pacemaker was implanted under the pectoralis major muscle after a muscle spreading incision was made. The lead was also introduced into the subclavian vein under the pectoralis muscle. No complications resulted, and the cosmetic result was judged to be good to excellent by the parents and physicians. No infections or erosions occurred. The subpectoral pocket is recommended as the preferred site for implantation of transvenous pacemakers in pediatric patients.