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Ann Thorac Surg 1999;68:173-175
© 1999 The Society of Thoracic Surgeons

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Original Articles

Placement of a permanent epicardial pacemaker in children using a subcostal approach

^a Division of Cardiothoracic Surgery, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA
^b Division of Pediatric Cardiology, New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA

Address reprint requests to Dr Warner, Division of Cardiothoracic Surgery, New England Medical Center, 750 Washington St, Boston, MA 02111
e-mail: kenneth.warner{at}es.nemc.org

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.

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