UC Davis Director of Pediatric Electrophysiology Dan Cortez has set another world record: He is the first to implant a dual chamber leadless pacemaker in a child. His case report was published this week in the journal PACE: Pacing and Clinical Electrophysiology.
A 13-year-old patient was referred to the UC Davis pediatric electrophysiology clinic for presyncope, a feeling of lightheadedness or dizziness without actually fainting, after being monitored for years for congenital complete heart block.
Pacemakers are typically placed in children with congenital complete heart block, a rare condition that can lead to sudden death and affects 1 in about 15,000 to 22,000 children. Congenital complete heart block may occur due to repaired congenital heart disease or genetic predisposition. It can also be acquired from exposure to certain maternal antibodies.
After serial electrocardiograms and Holter monitors showed progressively lower average heart rates, Cortez talked with the patient and their family about pacemaker options.
Based on current research, leadless pacemakers are generally considered “better” than traditional pacemakers because they offer several advantages, including a significantly lower risk of complications like infection due to the lack of leads, a smaller incision site, no visible scar, fewer post-implant activity restrictions, and potentially improved quality of life due to reduced discomfort and cosmetic concerns; however, they may not be suitable for every patient depending on their specific heart rhythm needs and anatomy.
Dual chamber leadless pacemakers help regulate the heart’s rhythm by stimulating the heart’s upper (atrial) and lower (ventricular) chambers. Because the patient wanted to remain active in sports without restrictions, leadless pacing was presented as an option, and the family agreed.
First dual chamber leadless pacemaker implanted in a child
The AVEIR dual chamber leadless pacemaker was implanted via the patient’s right internal jugular vein (instead of the femoral vein) so the patient could move easily and return to sports sooner. The minimally invasive procedure took place in the UC Davis Electrophysiology Lab.
The patient had no complications during or after the procedure. Three months later, the patient was able to resume exercise and play sports.
The AVEIR device is different from traditional pacemakers in part because it has no leads or cords and is absorbed by the heart. It is also 10 times smaller than a traditional pacemaker. This pacemaker has been implanted in adults across the country since it received FDA approval in 2023.
“Everyone, kids included, can now have the benefits of pacemakers without leads and without the complications that come with leads long term,” Cortez said. “No matter what kind of pacing a kid needs — atrial or ventricular, or both — they can now safely receive leadless pacing and, after the short recovery period, have no restrictions to their activity level.”
In 2023, Cortez was the first physician in the world to implant a retrievable leadless pacemaker in a child the Aveir VR also manufactured by Abbott which was designed to be easily retrievable when the battery needs to be replaced).
Five years prior to that, Cortez was the first physician in the world to implant a Micra single-chamber leadless pacemaker through the internal jugular vein in a child with hopes of mitigating risks and complications to improve leadless pacemaker implantation and early retrieval as being feasible in pediatric patients.
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This article was written by Tricia Tomiyoshi at the University of California-Davis Health
http://dx.doi.org/10.1111/pace.15129
