Pacemaker and implantable cardioverter defibrillator implantation in pediatric patients

Area of Science:

• Pediatric Cardiology
• Biomedical Engineering
• Cardiac Electrophysiology

Background:

• Pediatric pacemaker implantation faces unique challenges, including somatic growth, active lifestyles, infection risk, and long-term survival expectations.
• Current pacemaker generators and leads are primarily designed for adult patients, leading to suboptimal outcomes in children.
• Existing studies on pediatric pacemakers are often small, heterogeneous, and lack control groups, limiting robust conclusions.

Purpose of the Study:

• To review the specific challenges and considerations for pacemaker implantation in pediatric patients.
• To compare the outcomes of different pacing systems, including endocardial and epicardial approaches with steroid-eluting leads.
• To provide guidance on the preferred pacing strategies for pediatric patients based on current evidence.

Main Methods:

• Review of existing literature on pediatric pacemaker implantation.
• Analysis of complications, lead performance, and long-term outcomes in children with pacemakers.
• Comparison of endocardial versus epicardial pacing systems, including those with steroid-eluting leads.

Main Results:

• Pediatric pacemakers and implantable cardioverter-defibrillators (ICDs) show good results, but lead-related complications requiring reintervention remain frequent.
• Simpler pacing systems, particularly single-chamber pacemakers, are associated with fewer future complications.
• Endocardial pacing demonstrates superior outcomes compared to epicardial pacing in children over 10-15 kg, especially without congenital heart defects or prior surgery.

Conclusions:

• Minimizing the number of implanted leads in children can reduce future complications.
• Atrial loop creation may facilitate lead adaptation during growth.
• Endocardial pacing is the recommended first choice for children weighing over 10-15 kg, offering better long-term outcomes.