Pediatric Micra leadless pacemaker implantation via internal jugular and femoral veins: experience with 11 patients.

In pediatrics, conventional transvenous and epicardial pacemaker systems carry complications, such as lead distortion due to growth and activity, in addition to lead and pocket complications. A retrospective review of pediatric leadless pacing at the University of Minnesota Masonic Children's Hospital (MN, USA) from 2018 through 2021 was performed. Diagnoses, rationale for pacing, demographics, pacing thresholds and longevity of devices were recorded. Twelve leadless pacemaker insertions and one removal were performed successfully in patients weighing 19-90 kg. Six patients had Micra implantation via the internal jugular vein without surgical cut-down. Up to 3 years of follow-up were noted, with median follow-up of 22 months. No late complications occurred. Leadless pacemaker implantation and early retrieval were feasible in pediatric patients. Pacemaker placement has been the standard of care for patients when the top and bottom chambers of the heart are not communicating electrically. Patients can either be born with this, or it can happen after heart surgery. Traditional pacemaker technique involves placing wires (leads) through veins to the heart and surgically implanting a generator in the body. This carries a risk of complications, mainly lead dislocation and fracture with growth and activity. The Micra leadless pacemaker mitigates this risk and can be implanted into the muscle of the right ventricle. There are currently only small case series and reports in the literature on Micra pacemaker implantation in pediatric patients with congenital heart disease. We implanted 12 such devices in 11 pediatric patients weighing 19–90 kg. Six of these implantations were deployed using the internal jugular vein and were successful. One patient had a pericardial effusion at the time of implantation. Overall, leadless pacemaker implantation in the pediatric population with congenital heart disease is feasible, but further data are needed to assess long-term safety.