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Ann Thorac Surg 2007;83:1423-1424
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Invited commentary

Cardiac, Thoracic, and Vascular Surgery, Mainz University Hospital, Langenbeckstr 1, #505, D-55131 Mainz, 55131 Germany

(Email: heinemann{at}uni-mainz.de).

The debate of when, where, and most importantly, how to permanently pace the heart of a small child is ongoing. In most surgeons’ opinion, an epi(myo-)cardial approach is preferable, although the individual access (ie, subxiphoid, sternotomy, lateral) may vary. Major concerns regarding unsatisfactory stimulation thresholds and significant morbidity are continually being discussed throughout the pediatric community. On the other hand, resultant endeavors to gain transvenous access to rapidly growing hearts have led to raised eyebrows of pediatric cardiac surgeons.

Therefore an essential part of the message communicated by Aellig and colleagues [1] is that the results currently yielded are not at all bad. The authors report their commendable experience in a wide variety of patients, even under very dismal circumstances. In essence, they were able to confirm (with the small generators and optimized electrodes available today) that excellent stimulation thresholds can be achieved with epicardial access and that pacemaker placement poses no major technical problem even in very small premature babies.

This article is one more proof of the fact that the way to success in congenital heart disease is a truly interdisciplinary approach with a very active surgical role, even (and probably especially) in indications seeming to be surgically unattractive. The merits to be gained by a little dedication to detail are nonetheless tremendous.

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1. Aellig NC, Balmer C, Dodge-Khatami A, Rahn M, Prêtre R, Bauersfeld U. Long-term follow-up after pacemaker implantation in neonates and infants Ann Thorac Surg 2007;83:1420-1424.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Markus K. Heinemann Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Heinemann, M. K. Search for Related Content PubMed PubMed Citation Articles by Heinemann, M. K. Related Collections Electrophysiology - arrhythmias Related Article