[Pacemakers in children]

This is a study of pacemakers in 32 children with permanent pacemakers, 7 of them for congenital block, and 25 for post-operative block, representing a total of 69 pacemaker implantations. After a brief survey of the results, there is a discussion of the problems of the indications, relative for the congenital blocks, and absolute for the surgical blocks after a short period of observation. The choice of type of pacemaker rests upon three essential features: minimum inconvenience, a good length of active life, and the facility of an increased rate. Recent technical progress has allowed these features to be combined. The pacemakers currently available are shown on a table. The results are to a large extent determined by extreme care being taken over the implantation; meticulous asepsis, a low threshold on the electrode test, a pacemaker which is "comfortable" in its site, all these are essential if the serious complications are to be avoided, namely infection and pacemaker failure. The best route for the child, as for the adult, is by way of an epigastric approach with an abdominal pocket. In the very small infant, it seems better to implant by left thoracotomy, and to site the pacemaker intrapleurally.