Novel Neonatal Pacemaker Implant

Abstract

Background: Pacemaker implantation in neonates with congenital complete heart block (CCHB) are a small percentage of all pacemaker implants. Epicardial leads are predominantly implanted due to small patient size and concerns about venous occlusion. Standard pacemaker generators are large compared to the small size of neonates, which increases the risk of skin erosion, infection and respiratory impact if implanted in the thorax. Withdrawal of the smallest standard pacemaker generator, the MicronyTM from Abbott, has exacerbated the size mismatch issue. Medtronic has developed a novel paediatric implantable pulse generator (IPG) that consists of a MicraTM subassembly incorporated in a polymer header, which connects to a standard bipolar epicardial lead. This case reports the first neonatal paediatric IPG implant in the southern hemisphere. Case Presentation: A male fetus was antenatally diagnosed with CCHB at 28 weeks’ gestation with negative ENA antibodies. The neonate was delivered at 39 weeks’ gestation and had a class I indication for pacing for complete congenital atrioventricular block given a wide QRS escape rhythm. The Queensland Paediatric Cardiac Service received access to the paediatric IPG for compassionate use. At age 24 days, the 3.5 kg neonate had a bipolar epicardial lead implanted onto their left ventricle via a thoracotomy, which was tunnelled to the upper abdomen and connected to the pediatric IPG. Lead testing was satisfactory. The patient remains well at 9 months of age. Discussion: The paediatric IPG can be implanted successfully in neonates with CCHB, likely reducing the risk of complications from standard pacemaker generators.