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Paediatric Pacemaker Implantation

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The image illustrates the Transvenous and Epicardial pacemaker.
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A Comprehensive Guide toPaediatric Pacemaker Implantation

A permanent pacemaker is a compact, life-changing device designed to emit electrical signals that initiate or regulate a slow heartbeat. It's particularly beneficial for children whose natural heart pacemaker, the sinoatrial (SA) node is not developed properly or got damaged during any cardiac surgery usually performed to correct birth defects.

In neonates and infants( aged less than 1 years), pacemakers are typically implanted in the abdomen, with the connecting wires placed on the heart's exterior surface. This strategic placement leverages the natural padding of the abdomen, safeguarding the device and wires from potential injuries that can occur during common childhood activities, such as climbing, running and falling. As for children and adolescents, the pacemaker is usually placed under the collarbone in the shoulder area.

Trust in the hands of Dr Karthigesan, a renowned name in paediatric cardiology, for the safe and expert implantation of paediatric pacemakers. His extensive experience and compassionate approach ensure a smooth journey towards a healthier heartbeat for your child. Secure your child's heart health with Dr Karthigesan - guiding young hearts towards the rhythm they deserve.

The hands of an adult and a child holding a heart model illustrate Paediatric Pacemaker Implantation.
A heart expert holding a heart model and touching a virtual circuit symbol illustrates Pacemakers in Children.

Types of Pacemakers in Children

The pacemaker, a crucial piece of technology for heart health, is composed of 2 integral parts: the pacing leads and the pulse generator. The pulse generator is the device's hub, housing both the intricate electronic circuits and the battery that powers it. On the other hand, pacing leads connect the pulse generator with the heart using flexible and insulated wires. These leads are responsible for delivering electronic impulses to the heart. When it comes to children, pacemakers come in three primary types:

  • Single chamber pacemakers - These pacemakers feature a single lead. They are simple yet effective, designed for specific heart conditions.
  • Dual chamber pacemakers - Equipped with two leads, these devices offer a higher level of synchronisation between the chambers of the heart.
  • Biventricular pacemakers - With three leads, these pacemakers provide advanced therapy for more complex heart conditions.

Assessing the Need for a Paediatric Pacemaker Implantation

The journey towards pacemaker implantation begins with a comprehensive evaluation of your child's health. Dr Karthigesan initiates the process with a thorough analysis, covering your child's symptoms, their medical history, and your family's medical history. Recommended tests include:

  • Echocardiogram (Echo): This test offers a detailed examination of the heart's chambers, walls, and valves, providing a clear view of how effectively the heart pumps blood.
  • Holter monitor: This device records your child's heart rhythm during daily activities, offering real-time insight into any anomalies that may occur during regular movement and play.
  • External loop recorder: An External/Event Loop Recorder serves as a recording device designed to monitor and record heart rhythms. Worn around the clock, it consistently monitors your child's heart activity, capturing and storing instances of irregular electrical patterns.
  • Cardiac event monitor: Essentially a portable EKG machine, this tool is designed to record heart rhythms that occur infrequently, such as those that might only manifest a few times a month.
  • Stress test: This test involves an EKG recording of heartbeats during increased activity levels, providing valuable data on how the heart responds to physical stress.
Paediatric Pacemaker Implantation is monitored with medical devices.

The Paediatric Pacemaker Implantation Procedure

The process of pacemaker implantation in children involves a careful strategy, with the selection of the implantation route — transvenous (endocardial) or surgical (epicardial) — depending on the patient's size, anatomy, and any prior surgical procedures that might affect access to specific cardiac structures.
The image of a cardiac pacemaker.Decorative red spiral.Decorative blue spiral.

For older children and teenagers receiving a transvenous pacemaker:

  • A small prick is made just beneath the collarbone.
  • The pacemaker lead(s) are then introduced into the heart through a blood vessel running under the collarbone.
  • This procedure is typically performed in a catheterisation laboratory.

For younger children, the process is slightly different:

  • The pacemaker is placed into the abdomen via a small keyhole.
  • A second keyhole is made in the chest to visualise the heart.
  • The lead(s) are guided to the heart and placed on the heart's surface.
  • This procedure is executed in an operating room.

The pacemaker implantation procedure generally lasts for two hours. Following the completion of the procedure, the child enters a recovery phase lasting several hours. Typically, children are ready to return home within one to two days after the procedure.

Guidance for Before, During & After the Procedure

  • As your child will be given general anaesthesia, refrain from allowing them to eat or drink for eight hours prior to the surgery.
  • Inform your doctor about any illnesses your child might be experiencing, including fever, cold, cough, vomiting, diarrhoea, or diaper rash. Also, report recent exposure to chickenpox.
  • Inform the doctor if your child is currently on aspirin, warfarin, or other blood thinners.
  • The area for the pacemaker implantation will be cleaned thoroughly.
  • To maintain sterility, your child will be covered with surgical drapes. General anaesthesia will be administered for their comfort.
  • Upon completion of the procedure, the wound will be sealed with stitches under the skin, and a dressing will be applied over it.
  • Post-procedure, certain activities will be restricted for a varying period, from days to weeks.
  • Patients with newly implanted pacemakers are advised not to participate in contact sports for about six weeks.
  • Patients will be cautioned to avoid certain electronic devices that could potentially interfere with the pacemaker's function.
  • Regularly monitor your child's pulse to ensure the pacemaker is maintaining the desired pulse rate.
  • Schedule regular check-ups with your child's physician for optimal post-procedure care.

The Advantages of Using Pacemakers in Children

  • A pacemaker can be a lifesaver for your child by ensuring their heart maintains a regular rhythm, thus significantly enhancing their overall health and well-being.
  • With a pacemaker, your child can lead a vibrant, active lifestyle. With the right precautions, their day-to-day life will be unrestricted, full of play, learning, and growth.
  • Non-contact sports, riding roller coasters, and even learning to drive can safely be part of your child's life with a pacemaker.
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Embrace a Heartbeat

Full of Life and Joy

With pediatric pacemaker implantation, you're not just securing a healthy heartbeat for your child but also unlocking a future brimming with endless possibilities.

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Pediatric Pacemaker Implantation - Your Doubts Cleared

Pacemaker batteries are engineered to function efficiently for 8 years. The longevity of the pacemaker battery depends on the type of pacemaker, its utility and the place where the pacemaker was implanted- epicardial or transvenous.

When the time for a replacement arrives, it is accomplished via a straightforward procedure, referred to as a 'box change.' To ensure optimal performance of the pacemaker, regular pacing checks are conducted. As your child grows, it may be necessary to replace the existing wires that connect the battery to the heart with longer ones.

Post-procedure, as your child wakes up from the anaesthesia, they may experience some discomfort around the area where the pacemaker was implanted. To help manage this, pain relief medication will be administered. Once the scar from the implant heals, your child should not experience any further discomfort.
The key indicator of a properly functioning pacemaker is that your child's pulse rate will not dip below the rate indicated on their pacemaker card. If you need guidance on how to check your child's pulse, a member of our healthcare team, such as a cardiac nurse, GP's practice nurse, or health visitor, can guide you through the process.

After implantation, the first pacemaker check-up is scheduled for the following day, with the subsequent check-up set for six weeks later. Thereafter, annual check-ups are recommended once in 6 months, and these become more frequent as the pacemaker's battery approaches the end of its lifespan.

Pacemaker procedures in children pose unique challenges, primarily due to their smaller size, longer life expectancy, and potential anatomical variations linked to congenital heart defects. As such, pediatric pacemaker implantation requires specialised attention and differs from the procedure performed on adults.
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