VDD Pacing in Children with Congenital Complete Heart Block: Advantages of a Single Pass Lead

A single pass lead for VDD pacing in complete heart hlock is well descrihed in adults hut there are only brief reports of its use in children. We used standard adult size single pass leads in ten children and adolescents aged 3.7–17.2 years (mean 9.9 years) and weighing 13.5–76 kg (mean 35.4 kg) with congenital complete heart block. One patient had coexisting congenital heart disease and had undergone surgery. A 2:1 atrioventricular hlock in one patient was presumed to he congenital in origin. In four patients, the VDD system was their first pacing system. In six of the patients, 1–4 previous systems had been used and simultaneous extraction of ventricular leads (6) and/or atrial leads (2) was performed. Four different types of lead were used: Brilliant IMP15Q (Vitatron); Brilliant + IMR15Q (Vitatron): Cap-Sure 5032 (Medtronic); and Unipass 425–13 (Intermedics) witb four different generators: Saphir 600 (Vitatron): Saphir II 620 (Vitatron): Thera VDD 8948 (Medtronic): and Unity 292–07 (Intermedics). All leads were introduced via a suhclavian vein puncture and the atrial dipole was placed low in the right atrium to provide slack for further growth while maintaining atrial sensing. Ventricular thresholds ranged from 0.2–0.8 V. The minimal atrial amplitude was 0.7–4 mV and the maximum amplitude was 2.5–8 mV. There was one early microdisplacement and the lead was repositioned. Over a follow-up period ranging from 1–39 months (mean 20.4 months), all patients have maintained low ventricular pacing thresholds and adequate atrial signals for reliable pacing at rest and with exercise. During this time some bave undergone considerahle growth. The patient with coexisting congenital heart disease died suddenly at 3 years, hut the pacing system had no fault at autopsy. The standard adult size single pass lead provides a simple means to enable reliahle atrial synchronous ventricular pacing in growing children with complete heart hlock.