Safety and Feasibility of Implanting Patients Under 3kg with Dual Chamber Permanent Pacemakers

H. F. Ahmed¹, A. Guzman-Gomez², A. Ramineni², A. Ashfaq¹, S. Baskar², D. Lehenbauer³, F. Zafar⁴, D. Morales^5
1Cincinnati Childrens Hospital, Cincinnati, Ohio ²Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio ³Cincinnati Children's Hospital, Cincinnati, Texas ⁴Cincinnati Children's Hospital, Cincinnati, Ohio ⁵Cincinnati Children's Hospital Medical Center The University of Cinci, Cincinnati, Ohio

Purpose: Permanent pacing in young pediatric patients can be challenging for many reasons especially below certain sizes[1].Epicardial pacing is the preferred option in infants since transvenous systems are not feasible[2].We sought to describe institutional experience with surgical placement of dual chamber pacemaker systems in patients weighing ≤3kg at time of implant.

Methods: The Cincinnati Children’s Hospital database was used to identify all patients, ≤3kg at time of implant, from 2000-2022, who had an epicardial dual chamber permanent pacemaker (PPM) placed. Descriptive analyses were run with primary outcomes of interest, including post-implant complications & survival.

Results: Twenty-one patients had a total of 22 PPMs placed. Demographics at implant were: median age 6.0 days [3.0-27.0], length 46.3cm [45.6-49.0], weight 2.6kg [2.2-3.0] with the smallest being 1.9kg. Eight patients (38%) were premature ( < 37 wks) at time of implant and 2 (9.5%) had Trisomy 21. The majority of implants were done via median sternotomy [18 (82%)]. Most had generator placement in the left upper quadrant [14 (64%)] above the posterior fascia and below the rectus muscle. The various models of PPMs used are included in table 1. Indication for implant was congenital heart block [19 (91%)], of which 24% were due to maternal lupus. Two patients had PPM secondary to post-operative heart block & 3 (14%) had emergent temporary epicardial wires placed before PPM. Pacemaker-related complications were found in 1 (4.7%) patient (Post op. day 20) related to small wound dehiscence; no infection, and the dual chamber PPM was exchanged for a single chamber PPM. There were no PPM-related in-hospital mortalities or other complications including late PPM infections. Of the 21 patients, only 2 (9.5%) required a generator exchange within 1 year of initial placement (Table 1).

Conclusion: Implanting permanent pacemakers in ≤3kg children can be challenging, however, as is demonstrated in the current analysis, it can be done successfully with excellent outcomes. With the clear benefits of dual chamber pacing, single chamber PPM should not be used in neonates/infants with congenital heart block.

Identify the source of the funding for this research project: No