Introduction: Implanting a permanent pacemaker (PM) or cardio-defibrillator (ICD) in pediatric patients (pts) or Grown-Up Congenital Heart Disease is a medical and surgical challenge. The weight and size of the pts, the caliber of the veins, the peri-surgical risks, and the need of long-time stimulation required; are all issues that may represent potential risk for the implant and may influence clinical decisions. In this sense, the strategy of surgical approach as well as the decision of implanting dual-chamber devices, are crucial for prognosis and for adequate cardiac pacing during a long-term follow-up.
Material and Methods: We describe our experience with implantation of dual chamber PM trough endocardial access in 40 consecutive pts from May 2009 through March 2013. The analysis was retrospective, mean age 13 ± 5 years (5-31). The average weight was 38 ± 13 kg. (Range 16-64 kg.), and 37% (15/40) were women. Either left or right axilar vein punction was performed in 40/40 pts and the device was placed in a retro-pectoral pocket.
Results: The indication for dual chamber PM was complete A-V Bock in 28 cases (70%) for congenital in 18 and acquired in 10), severe post-surgery sinus node dysfunction in 5, ICD for VT in 6 pts with Long QT and CPVT, and 1 up-grade to Biventricular pacing in a patient with severe DCM and chronic AF with low heart rate. Ultra-thin 4 French catheters were used in 19 dual chamber PM, and 5.5 French catheters in the other 15 cases. We used 6 French catheters for defibrillation in 6 pts with ICD implantation. The successful implant to dual-chamber devices was achieved in 39/40 pts (97,5%) because in one pts, the LV lead could not be implanted secondary to complete thrombosis of the innominate vein. There were no acute or long-term follow up complications. At the time of latest schedule visits there were not any significant increment of stimulation thresholds or malfunction in any case.
Conclusions: in this selected population the implantation of endocardial dual-chamber devices through the axilar vein punction was feasible, safely and successful. The use of adequate ultra-thin catheters was a fundamental tool to obtain such results, and those catheters showed proper and stable stimulation capabilities over time.