PACING IN CHILDREN - INDICATIONS AND TECHNIQUES

Major technological advances in pacing therapy have occurred over the last 5-10 years. Many of these innovative designs are ideal for the pe diatric population and include significant diminution in size as well as physiological pacing techniques. Bradycardia remains the most frequ ent indication for implantation of a pacemaker, but antitachycardia pa cing has gained increasing use as well. Surgical considerations as to the type of device to be implanted include the presence and type of un derlying congenital heart disease, size and age of the patient, size o f the subclavian vein, and presence of venous anomalies. Implantation of epicardial devices is usual in infants and small children, whereas transvenous devices are implanted in older, larger children. Choice of bipolar or unipolar lead configurations must take into account the ty pe of device to be implanted (dual versus single chamber) as well as a natomic considerations. Dual versus single rate-responsive pacing can be considered on an individual basis. Mechanisms of lead fixation, i.e ., active versus passive, are discussed, as well as newer transvenous lead removal techniques.