A review of current approaches to pacing in children with atrioventricular blocks

Pacing is currently the main method of treatment in children with life-threatening bradyarrhythmias. The high-grade atrioventricular block remains the main indication for permanent pacing in children. The factors that determine the specificity of device implantation in the pediatric population are as follows: anthropometric data of a child and their compliance with the size of a pacemaker and the electrodes, the need for long-term (lifelong) cardiac stimulation and multiple replacements of a pacemaker, high level of child’s activity, changes in the physical parameters of the body over time (the need for implantation of the leads “with reserve” and their replacement), and, in some cases, the presence of concomitant congenital heart defects, especially, with intracardiac shunts. One of the controversial issues in pediatric cardiac stimulation is choosing a method of implantation (epicardial or endocardial). According to recent reports, the epicardial lead implantation techniques are increasingly being used because the transvenous pacemakers are associated with more serious complications and due to the capability to choose hemodynamically optimal stimulation zone in epicardial technique to prevent pacemaker-induced dyssynchrony. This approach allows to ultimately postpone the implantation of the endocardial stimulation system, administration of which is associated with the problem of endovascular lead extraction in children, the problem, which has not been resolved not only in Russia but also worldwide. This review article discusses recent literature on the use of permanent pacing in children, including the advantages and disadvantages of using the endocardial and epicardial pacemaker systems as well as various methods of implantation and pacemaker modes most often used in pediatric practice.