title: Cardiac pacing in premature infants and neonates: steroid eluting leads and automatic output adaptation.
abstract: BACKGROUND
  Appropriate generator and lead selection as well as techniques of implantation are most important aspects of cardiac pacing in the extremely young patient. Here we report the clinical results using a new technique with automatic output adaptation based on evoked response in combination with steroid-eluting epicardial leads in small children.
  
  
  METHODS
  One neonate and 2 premature infants underwent permanent pacemaker implantation because of congenital high-degree atrioventricular block or postoperative complete heart block, respectively. Steroid-eluting epicardial leads and a multiprogrammable pacemaker with automatic output adaptation were used.
  
  
  RESULTS
  Intermuscular abdominal generator placement and epicardial suture-fixation of the bipolar lead through a subcostal approach was without complications. Serial follow-up examinations revealed safe and consistent pacemaker function up to 12 months after operation.
  
  
  CONCLUSIONS
  The technique represents an excellent alternative for permanent cardiac pacing in extremely small patients. We believe that it provides an increase in functional lifetime of the devices and delays the need for battery replacement with its associated complications in this young patient population.
authors.affiliation: Department of Cardiothoracic Surgery, Medical Clinic, Johannes-Gutenberg University Hospitals, Mainz, Germany. schmidfx@main.uni-mainz.de
authors.forename: F X
authors.initials: FX
authors.lastname: Schmid
authors.forename: B
authors.initials: B
authors.lastname: Nowak
authors.forename: C
authors.initials: C
authors.lastname: Kampmann
authors.forename: M
authors.initials: M
authors.lastname: Hilker
authors.forename: H
authors.initials: H
authors.lastname: Oelert
mesh_terms: D000465:Algorithms; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000601:surgery*; D010138:Pacemaker, Artificial