title: [DDD-pacemaker implantation in a 7-week-old infant: epicardial electrodes in intrapleural position].
abstract: Permanent pacing for complete heart block in newborns and small infants is a challenge concerning the mismatch between body size and pacemaker dimensions. As the abdominal position of the large pacemaker carries a considerable risk of healing disturbances, the intrapleural position of single chamber pacemakers is accepted as well. We report about a 7 week old infant with congestive heart failure due to a complete atrioventricular septal defect. The immature valve tissue led to recurrent, severe mitral valve incompetence and necessitated several valvuloplasty procedures and finally the implantation of a mechanical prothesis. Because of a postoperative complete heart block, a dual chamber pacemaker with epicardial steroid-eluting bipolar leads was implanted without specific fixation into the right pleural cavity during delayed sternal closure to ensure atrioventricular synchrony. Despite the capacious implant, adverse effects on hemodynamics and pulmonary function were not observed and the infant thrived normally. The DDD function of the pacemaker allowed the utilization of the infant's complete heart rate spectrum without restrictions due to the technically limited upper tracking rate of 180 bpm.
authors.affiliation: Abteilung für angeborene Herzfehler/Kinderkardiologie Deutsches Herzzentrum Berlin Augustenburger Platz 1 13353 Berlin, Germany. nuernberg@dhzb.de
authors.forename: J H
authors.initials: JH
authors.lastname: Nürnberg
authors.forename: M
authors.initials: M
authors.lastname: Hübler
authors.forename: G
authors.initials: G
authors.lastname: Senft
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
authors.forename: P E
authors.initials: PE
authors.lastname: Lange
mesh_terms: D000367:Age Factors; D005500:Follow-Up Studies; D006327:Heart Block / Q000628:therapy*; D006343:Heart Septal Defects / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve; D008944:Mitral Valve Insufficiency / Q000601:surgery; D010138:Pacemaker, Artificial; D010994:Pleura; D011183:Postoperative Complications; D013997:Time Factors