Pacemakers for Children

A pacemaker is a device that uses low energy electrical pulses to prompt the heart to beat whenever a pause in the rhythm is detected. They can help to coordinate electrical signals between the upper and lower chambers so they will beat in a coordinated fashion. Pacemakers can help speed up a slow heart rate.

It has 2 components: lead(s), which is a specialized wire to deliver energy from the pacemaker to the heart muscle and the generator (battery pack).

Disorders

Pacemakers are used for patients that have an abnormally slow rhythm. Pacemakers may be indicated in patients with symptomatic bradycardia (slow heart rate), heart block, or sinus node dysfunction.

Pacemakers may also treat abnormally fast rhythms from the atria (upper chambers of the heart) by overdrive pacing.

Pacemakers may be implanted in patients with a normally structure heart or those with congenital heart disease.

On the Inside

Children can have a lead on the top chamber of the heart (atrium) or the bottom chamber of the heart (ventricle) or both. Sometimes leads are placed on both ventricles.

Pacemakers can be implanted in two basic ways in children and adolescents. The systems can be epicardial (leads outside the heart) or transvenous (leads inside the veins leading to the heart).

Transvenous pacing system: The leads are inserted into the vein just below the clavicle (collar bone), threaded through the large vein leading into the heart (superior vena cava) and placed in the top chamber of the heart (atrium) or the bottom chamber of the heart (ventricle) or both. Transvenous leads generally last longer than epicardial but do have an incidence of long-term problems that will be explained to you by your physician.

Epicardial pacing system: The leads are attached to the outside of the heart (epicardial surface) because the young child’s veins leading to the heart are too small for a lead to fit safely inside the vein or because of congenital heart disease In many cases the epicardial pacing leads can last until the child is old enough for safe implantation of a transvenous pacing system. A new type of pacemaker without leads was recently developed. This leadless pacemaker is currently available for adults patients,

The type of pacemaker used is based on your diagnosis, age and size.

During implantation, your child is under general anesthesia meaning completely asleep and unaware of their surroundings. In older patients, they may have a lighter form of anesthesia called consciousness sedation or moderate sedation.

Patients will have a small incision where the battery was placed.

Recovery from implantation of a pacing system varies, depending on the child and whether or not other heart surgery was performed at the time. Typically, a child leaves the hospital two to three days after implantation of a pacing system if this is the only surgery performed at the time. Restriction of arm movement may be necessary for certain types of procedures.

Lifestyle Changes

Activity restrictions or precautions may be recommended depending on your child's heart disease. Your cardiologist will review these recommendations with you.

Patients with pacemaker's will require future procedures related to the pacemaker generator (battery pack) longevity or battery life. The pacemaker generator (battery pack) typically last 7-12 years.

The lead(s) only need to be changed if they stop functioning. In some instances, the lead has to be removed and replaced.

Routine visits with the cardiologist and/or electrophysiologist provide the best care for the pacemaker. At these appointments the pacemaker leads and battery are tested.

Today's advanced technology provides a way to check a pacemaker at home (remote monitoring). A monitor will be set up by your child's doctor or pacemaker clinic if it is part of their plan of care. The monitor will collect information from the pacemaker and send it securely over the phone system and internet to the pacemaker clinic. Your child's doctor will determine how often and when transmissions are to be sent using the monitor versus when you need to come to the hospital to have the pacemaker checked in person.