title: Twenty-Seven Years Experience With Transvenous Pacemaker Implantation in Children Weighing <10 kg.
abstract: BACKGROUND
  Epicardial pacemaker implantation is the favored approach in children weighing <10 kg in many units. The high incidence of premature failure and fractures with earlier epicardial leads led our unit to undertake transvenous pacemaker implantation in neonates and infants from 1987. To date there have been no long-term follow-up reports of what is for many a controversial strategy.
  
  
  RESULTS
  Between 1987 and 2003, 37 neonates and infants-median age 6.7 months (1 day to 3 years) and median weight 4.6 kg (2.7-10 kg)-had a permanent transvenous pacing system implanted. Pacing leads were placed into the right ventricular apex/outflow tract through a subclavian vein puncture with a redundant loop in the atrium. Three patients were lost to follow-up, 4 patients died from complications of cardiac surgery, and 2 patients had their system removed. At long-term follow-up in 28 patients at a median of 17.2 (range, 11.2-27.4) years, 10 patients have a single chamber ventricular pacemaker, 14 a dual chamber pacemaker, 3 a biventricular pacemaker, and 1 has a single chamber implantable cardioverter defibrillator. Subclavian vein patency was assessed in 26 patients. The overall subclavian vein occlusion rate was 10 of 13 (77%) <5 kg and 2 of 13 (15%) >5 kg during long-term follow-up. After a median of 14.3 (range, 13.4-17.6) years of pacing, 7 patients continue with their original lead.
  
  
  CONCLUSIONS
  Transvenous pacing in infants <10 kg results in encouraging short- and long-term clinical outcomes. Subclavian vein occlusion remains an important complication, occurring predominantly in those weighing <5 kg.
authors: From the Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom (L.K., M.H.C., J.B., J.R., E.R.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (M.H.C.).
authors: Laura
authors: L
authors: Konta
authors: From the Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom (L.K., M.H.C., J.B., J.R., E.R.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (M.H.C.).
authors: Mark Henry
authors: MH
authors: Chubb
authors: From the Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom (L.K., M.H.C., J.B., J.R., E.R.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (M.H.C.).
authors: Julian
authors: J
authors: Bostock
authors: From the Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom (L.K., M.H.C., J.B., J.R., E.R.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (M.H.C.).
authors: Jan
authors: J
authors: Rogers
authors: From the Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom (L.K., M.H.C., J.B., J.R., E.R.); and Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom (M.H.C.). Eric.Rosenthal@gstt.nhs.uk.
authors: Eric
authors: E
authors: Rosenthal
mesh_terms: D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001835:Body Weight; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000401:mortality; D058409:Cardiac Resynchronization Therapy Devices; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002675:Child, Preschool; D017147:Defibrillators, Implantable; D020878:Device Removal; D004554:Electric Countershock / Q000295:instrumentation; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D011677:Punctures; D012307:Risk Factors; D013350:Subclavian Vein; D013997:Time Factors; D016896:Treatment Outcome
keywords: biological pacemakers; defibrillators, implantable; infant; infant, newborn; subclavian vein