Dual Chamber Aveir Retrievable Leadless Pacemaker Implant via the Right Internal Jugular Vein in a 13-year-old With Congenital Complete Heart Block.

Abstract

Introduction: Congenital complete heart block is a condition where there is a risk of Stokes Adam's attacks and sudden death may occur. Once the escape rate is too low, or other high-risk factors occur, these patients ultimately need pacemakers placed. Epicardial or transvenous pacemakers have typically been in employed dependent on size of the patient and other circumstances. We describe the first case of an implant via internal jugular vein (right) of a dual chamber leadless pacemaker implant in a symptomatic pediatric patient with congenital complete heart block.

Methods: The study was approved by the University of California and consent was waived due to retrospective nature of this case report.

Case: A 13-year-old presented with presyncope at rest after years of being followed for her congenital complete heart block. Her average rate on Holter monitoring was below 50 bpm, which coincided with her recent symptoms. After discussion with family, and our own cardiology/surgical team, she had a dual chamber leadless pacemaker implanted. Stable 3-month atrial parameters included an impedance of 340 Ω, sensing of 3.2 mV, and threshold of 0.25 V at 0.2 ms, while ventricular parameters showed an impedance of 780 Ω, sensing of 14.2  mV, and threshold of 0.5 V at 0.2 ms.

Conclusion: Dual chamber leadless pacemaker implant is feasible via right internal jugular vein access and in a pediatric patient.