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Ann Thorac Surg 1999;67:1400-1402
© 1999 The Society of Thoracic Surgeons

Original Articles

Cardiac pacing in premature infants and neonates: steroid eluting leads and automatic output adaptation

Franz X. Schmid, MDa, Bernd Nowak, MDb, Christoph Kampmann, MDc, Michael Hilker, MDa, Hellmut Oelert, MD, PhDa

a Department of Cardiothoracic Surgery, Johannes-Gutenberg University Hospitals, Mainz, Germany
b Medical Clinic, Johannes-Gutenberg University Hospitals, Mainz, Germany
c Department of Pediatric Cardiology, Johannes-Gutenberg University Hospitals, Mainz, Germany

Accepted for publication November 3, 1998.

Address reprint requests to Dr Schmid, Department of Cardiovascular and Thoracic Surgery, Johannes Gutenberg-University Hospitals, Langenbeckstr 1, D-55101 Mainz, Germany
e-mail: schmidfx{at}mail.uni-mainz.de

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.




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