Intrapleural dual chamber pacemaker implantation in a 7 week old infant

Permanent pacing for complete heart block in newborns and small infants is a challenge concerning the mismatch between body size and pacemaker dimensi ons. As the abdominal position of the large pacemaker carries a considerabl e risk of healing disturbances, the intrapleural position of single chamber pacemakers is accepted as well. We report about a 7 week old infant with c ongestive heart failure due to a complete atrioventricular septal defect. T he immature valve tissue led to recurrent, severe mitral valve incompetence and necessitated several valvuloplasty procedures and finally the implanta tion of a mechanical prothesis. Because of a postoperative complete heart b lock, a dual chamber pacemaker with epicardial steroid-eluting bipolar lead s was implanted without specific fixation into the right pleural cavity dur ing delayed sternal closure to ensure atrioventricular synchrony. Despite t he capacious implant, adverse effects on hemodynamics and pulmonary functio n were not observed and the infant thrived normally. The DDD function of th e pacemaker allowed the utilization of the infant's complete heart rate spe ctrum without restrictions due to the technically limited upper tracking ra te of 180 bpm.