Successful atrial leadless pacemaker implantation in an 11-year-old with congenital sinus node dysfunction: A Case Report

Background Sinus node dysfunction (SND) is rare in the paediatric population. Leadless atrial pacing represents a novel therapeutic option. To our knowledge, this case represents the youngest reported patient to receive an atrial leadless pacemaker (AVEIR AR). While ventricular leadless pacing has been described in children, atrial leadless pacing experience in this population remains extremely limited. Case Summary An 11-year-old boy with lifelong bradycardia documented since fetal life presented with exertional dyspnoea and recurrent syncopal episodes. Electrocardiography revealed nodal rhythm without sinus activity. Electrophysiological evaluation demonstrated a corrected sinus node recovery time (cSNRT) of 4800 ms and absence of chronotropic response to intravenous atropine (0.04 mg/kg IV). The patient met Class I criteria for permanent pacemaker implantation according to current paediatric pacing consensus recommendations, given symptomatic sinus node dysfunction with chronotropic incompetence. An AVEIR AR leadless pacemaker was successfully implanted at the base of the right atrial appendage with optimal electrical parameters. No procedural or 18-month follow-up complications were observed. Discussion This case demonstrates procedural feasibility of atrial leadless pacing in a carefully selected paediatric patient, with encouraging mid-term follow-up. Larger studies are required to establish long-term safety and clinical outcomes.