Placement of a permanent epicardial pacemaker in children using a subcostal approach.
BACKGROUND
Previously described techniques for epicardial pacemakers in children have generally included either a left thoracotomy approach or a subxiphoid incision.


METHODS
We have recently used a single left subcostal incision for placement of both the epicardial electrodes and the pacemaker generator. We report our initial experience with this technique in 8 patients. The mean age was 4 years (range, 4 months to 12 years). The smallest patient weighed 4,100 g.


RESULTS
The subcostal approach was successful in 7 patients. One patient with a narrow costal margin operated on early in our experience required conversion to a thoracotomy. The pacing thresholds were uniformly excellent in all patients. There have been no associated complications.


CONCLUSIONS
Placement of epicardial leads using a left subcostal incision avoids a thoracotomy, is simpler than a subxiphoid approach, and results in acceptable thresholds with minimal morbidity.
Division of Cardiothoracic Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts 02111, USA. kenneth.warner@es.nemc.org
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Warner
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Halpin
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Berul
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Payne
D002648:Child; D002675:Child, Preschool; D006327:Heart Block / Q000601:surgery; D006801:Humans; D007223:Infant; D010138:Pacemaker, Artificial; D012804:Sick Sinus Syndrome / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000379:methods