SINGLE-PASS VDD PACING IN CHILDREN AND ADOLESCENTS

Use of a single pass lead for VDD pacing in complete heart block is we ll described in adults, but there are only brief reports of its use in children. We have used standard adult size single pass leads in 13 ch ildren and adolescents aged 3.7-17.2 years (mean 10.1 years) and weigh ing 13.5-76 kg (mean 34.8 kg). Congenital complete heart block was pre sent in 7 patients, surgical complete heart block in 5 patients and 2: 1 AV block of unknown cause in 2 patient. In four patients, the VDD sy stem was their first pacing system. In nine of the patients, 1-6 previ ous systems had been used and simultaneous extraction of ventricular l eads and/or atrial leads was performed. Leads of four different types were used: Brilliant IMPI5Q, Brilliant + IMR15Q, CapSure 5032, and Uni pass 425-13 with 4 different generators: Saphir 600, Saphir II 620, Th era VDD 8948, and Unity 292-07. At implantation, via a subclavian vein puncture, excess lead was advanced into the right atrium to allow bot h atrial sensing and slack for further growth. Ventricular thresholds ranged from 0.2-0.7 V. The minimal atrial amplitude was 0.7-4 mV and t he maximum amplitude was 2.5-8 mV. There were no complications. All pa tients have maintained adequate atrial signals for reliable pacing wit h follow up of 3-36 months (mean 17.6 months) during which time some h ave undergone considerable growth. Reliable atrial synchronous ventric ular pacing is possible in growing children with complete heart block using a standard adult single pass lead.