Aims: In the first instance epicardial leads and an abdominal pacemaker are implanted in newborns and small infants. In case of recurrent complications, early conversion to transvenous leads might improve long-term outcome and reduce frequent revisions.
Methods: We report on three children with post surgical atrio-ventricular block and an epicardial pacemaker system. All three infants underwent several revisions within 3 years because of lead complications, local infection and early battery depletion due to a high threshold. To avoid further complications and recurrent epicardial surgery, all three systems were successfully replaced (bodyweight 6.1, 6.8, 9.8 kg) using a 4.5 French bipolar transvenous lead and a small pacemaker.
Results: During the mean follow-up time of 9.1 years no further complications occurred. After a mean implantation period of 6.6 years all pacemakers were replaced with continuing use of the prior implanted ventricular leads. Increase in weight and growth were adequate to the clinical conditions in all three patients.
Conclusion: Transvenous lead implantation showed fewer complications than epicardial leads did and a reduction in re-operations. Also for patients with a weight between 6 and 10 kg the long term results of the transvenous approach with a thin lead is of benefit.