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Congenital Heart Disease
Cardiac pacing in infants and children
  1. Karen A McLeod
  1. Correspondence to Dr Karen A McLeod, Royal Hospital for Sick Children, Glasgow, Yorkhill, Dalnair Street, Glasgow G3 8SJ, UK; karen.mcleod{at}

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Paediatric pacemaker implants comprise <1% of all pacemaker implants.w1 When it is considered that the mean age of pacemaker implantation in the adult population is 75.5 years, compared with <10 years in the paediatric population, the problems of small size, growth and truly chronic pacing faced by the paediatric implanter are fully appreciated.w1

Who needs a pacemaker in childhood?

The American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) 2008 guidelines for device-based therapy of cardiac rhythm abnormalities include up to date guidelines for implantation of pacemakers in children, adolescents and patients with congenital heart disease.1 The main indication for pacing in childhood is symptomatic or worrying bradycardia, the most common being complete heart block (box 1).2 Heart block may occur in children with structurally normal hearts (isolated heart block) or those with congenital heart disease.

Box 1 Indications for pacemaker implantation in childhood*

Complete atrioventricular block following cardiac surgery

Symptomatic congenital complete heart block

Asymptomatic congenital complete heart block in association with:

  •  Low mean heart rate <50–55 bpm in neonates

  •  Nocturnal pauses

  •  Bradycardia related arrhythmias

Acquired heart block in myopathies

Symptomatic bradycardias in:

  •  Sick sinus syndromes

  •  Long QT syndromes

Reflex anoxic seizures with secondary anoxic epileptic seizures

  • * For a comprehensive list of indications (including relative indications), the reader is referred to the AHA/NASPE/HRS 2008 guidelines.1

Isolated heart block

Isolated complete heart block in childhood can broadly be divided into two groups—antibody positive and antibody negative.3 The antibody positive group develop heart block in fetal life as a result of maternal antibodies to single stranded RNA crossing the placenta and damaging the conduction system. The antibody negative group tend to present at a later age and heart block is often progressive. Many children with isolated complete heart block are well and asymptomatic. Pacing is indicated for those with symptoms, but there is a risk of sudden death even in asymptomatic patients. …

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  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. Dr McLeod implants Medtronic and St Jude Medical devices and has in the past received support for research projects from these companies.

  • Provenance and peer review Commissioned; not externally peer reviewed.