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Migration of an epicardial pacemaker to the pericardial space in an infant
G F Van Hare1, C Witherell, S M Merrick
1Department of Pediatrics, Rainbow Babies and Childrens Hospital, Cleveland, Ohio 44106.
Insights
A pacemaker pulse generator migrated in an infant with prolonged QT syndrome. This rare complication followed the lead
Area of Science:
- Pediatric Cardiology
- Medical Device Complications
- Cardiac Electrophysiology
Background:
- Congenital long QT syndrome (LQTS) necessitates pacing in infants.
- Epicardial ventricular pacing systems are used for LQTS management.
- Early implantation in neonates poses unique challenges.
Observation:
- A 4-month-old infant received an epicardial ventricular pacing system at 6 days of age for LQTS.
- The infant later developed pulse generator migration.
- The migration pathway involved tracking through the diaphragm into the pericardial space.
Findings:
- Pulse generator migration into the pericardial space occurred.
- The myocardial lead's path facilitated the migration.
- Potential for diaphragm and pericardium disruption exists.
Implications:
- Clinicians must consider pulse generator migration in infants with pacemakers.
- Careful monitoring is crucial for pediatric patients with implanted cardiac devices.
- This case highlights potential risks associated with early pacemaker implantation in neonates.
Abstract:
We report the case of a 4-month-old infant who was implanted with an epicardial ventricular pacing system at 6 days of age for the prolonged QT syndrome, who subsequently developed migration of the pulse generator to the pericardial space. Tracking of the pulse generator through the diaphragm and into the pericardium followed the route of the myocardial lead. The possibility of pulse generator migration, as well as disruption of the diaphragm and pericardium, should be considered by those who care for infants with implanted pacemakers.