Pacemakers in children and adolescents

Abstract

Children have been the beneficiaries of pacing therapies since the pioneering days of the technology. Yet, despite the fact that paediatric pacemaker implants represent around 1% of all pacemaker implantations, there are no guidelines at present dedicated to pacing in this population. This chapter discusses the challenges and needs specific to pacing therapy in children, such as the small stature and the continual somatic growth of paediatric patients; the prevalence of intracardiac shunting; and the often complex anatomical heart structures in children with an indication for pacing. Such differences from adult pacemaker recipients are reflected in the decisions on, for example, implantation route (epicardial versus endocardial), on choice of single-chamber versus dual-chamber devices, selection of pacing sites, or programming. The chapter also highlights questions about lead removal, which is particularly important given the sheer number of replacements expected in paediatric patients, and provides an outlook towards the future of pacing in children and the role of leadless devices and future therapeutic advances.