Marketed for adults in the United States since 2023 and available in France in a few centers as part of a Limited Market Release (LMR) recently, the miniaturized double-chamber leadless pacemaker manufactured by the Abbott laboratory was implanted in a 13-year-old patient by the team of Professor Daniel Cortez from the University of California (UC Davis). This is the first time that this operation has been performed with this type of pacemaker in children. Professor Cortez, already at the origin of other “first” pacemaker implantations in children, reports this case in the journal Pacing and Clinical Electrophysiology (PACE).
Pacemakers are usually placed in children suffering from complete congenital heart block, a rare condition that can lead to sudden death and affects 1 in 15,000 to 22,000 children. These are epicardial or transvenous pacemakers that are used in depending on the size of the patient, but these present certain risks or complications linked to the device itself or to the anatomical particularities of the patients.
This clinical case shows the feasibility of implanting a dual-chamber pacemaker without a lead in children, passing through the right internal jugular vein, offering a major advantage since it is smaller than a battery. AAA. Note that leadless ventricular pacemakers have already been placed in children, notably by Professor Cortez.
“Do sport without restrictions”
The 13-year-old female patient was referred to the UC Davis Pediatric Electrophysiology Clinic for resting presyncope; she was followed for complete congenital heart block. As her test results showed increasingly lower average heart rates (49 bpm), the patient was eligible for a pacemaker.
Her congenital pathology requiring atrial and ventricular stimulation, and the latter having expressed the wish to be able to continue to “play sports without restrictions”the leadless dual-chamber stimulator seemed to be the most interesting therapeutic option. “The family's preferences were for the leadless pacemaker rather than standard pacemakers – epicardial or transvenous”relates Professor Cortez in his clinical case. “They also preferred the jugular vein approach rather than the femoral one so that the patient could return to walking and playing sports more quickly. » The team reports no perioperative complications with, at three months, a resumption of physical and sporting activities.
New perspectives for pediatric cardiology
“Everyone, including children, can now enjoy the benefits of leadless pacemakers and without the complications that come with long-term leads”Daniel Cortez said in a UC Davis press release. In addition, the Aveir device offers the possibility of first implanting a first ventricular or atrial capsule and, if necessary, adding another capsule without changing the device, depending on the evolution of the pathology. “No matter what type of stimulation a child needs, they can now safely benefit from leadless stimulation and, after the short recovery period, have no restrictions on their activity level,” adds Professor Cortez.
