Intravenous Pacemaker Lead Implantation for a Pedatric Patient-16-Year-Follow-Up

Introduction: Cardiac pacing for small children has been performed using a myocardial lead. Intravenous pacemaker lead implantation has a lot of advantages such as lower frequency of exit block and better pacing threshold compering to myocardial lead. However, intravenous pacemaker lead implantation has not been aggressively performed, because this approach for small children requires consideration of future growth, an appropriate entry site to avoid venous obstruction, and selection of lead. Patient and Method: The patient is a 4-year-old male underwent total correction of pulmonary atresia with ventricular septal defect following a lot of previous palliative surgery. Use of a myocardial lead was initially considered to treat sick sinus syndrome after total correction. However, it seemed difficult to attach a myocardial lead to the best place in the right atrium for AAI pacing, due to previous thoracotomies and cardiac surgery. Screw-in type lead was attached to the free wall of the right atrium and excess loop was left to adapt his growth. During the 16-year follow-up period, no adverse phenomenon such as an exit block, sensing failure, or free-floating of the lead were observed. Conclusion: The selection of a small size endocardial lead and an appropriate entry vein make implantation of an endocardial lead for small children easier and safety.