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eComment: Re: Intra-diaphragmatic pacemaker implantation in very low weight premature neonate

Bakoulev Center for Cardiovascular Surgery, 121552 Moscow, Russia

Intra-diaphragmatic pacemaker implantation in very low weight premature neonate

The article is dedicated to intra-diaphragmatic pacemaker (PM) implantation in a very low weight premature neonate [1]. The leads were implanted epicardially. In the literature there are no analogue PM implantation in such a low weight premature neonate.

As from our experience neonate without co-existing pathology and rhythm >80 beats/min are doing well up to five years. But low weight premature neonate, especially with rhythm <50 beats/min or with co-existing heart pathology are suffering from such a low rhythm. The same is true for the neonates after congenital heart surgery when complete heart block is a surgical complication. PM implantation in such group of neonates has no strong recommendations for leads implantation (epicardial or endocardial placement). In particular Cohen et al. [2] had successfully implanted 60 epicardial leads and PMs to children with congenital complete heart block. Subsequent improvements of PMs and leads did not change the appearance of the surgical technique.

We have implanted 15 PMs in neonates, including 75% of dual-chamber PM in neonates with different co-existing pathologies. We have used classical implantation technique of the device in the abdominal wall even in neonates of <2000 g.

Bakhtiary et al. [3] described their experience of 21 implanted PMs; 15 of them were dual-chamber and neonates (average weight was 3120±230 g). All PMs were implanted in the abdominal wall.

Antretter et al. [4] described the successful single-chamber PM implantation in a neonate with endocardial lead via the left subclavian vein. The PM was implanted under m. pectoralis major. Operation and postoperative period were without complication. PM pocket was performed intramuscularly or under the muscle (depending on implantation place).

The surgical technique described in this article has a particular interest as it is new and non-standard.

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1. Roubertie F, Le Bret E, Thambo JB, Roques X. Intra-diaphragmatic pacemaker implantation in very low weight premature neonate. Interact CardioVasc Thorac Surgery 2009;9:743–745.
2. Cohen MI, Rhodes LA, Spray TL, Gaynor JW. Efficacy of prophylactic epicardial pacing leads in children and young adults. Ann Thorac Surg 2004;78:197–203.[Abstract/Free Full Text]
3. Bakhtiary F, Dzemali O, Bastanier CK, Moritz A, Kleine P. Medium-term follow-up and modes of failure following epicardial pacemaker implantation in young children. Europace 2007;9:94–97.[Abstract/Free Full Text]
4. Antretter H, Colvin J, Schweigmann U, Hangler H, Hofer D, Dunst K, Margreiter J, Laufer G. Special problems of pacing in children. Indian Pacing Electrophysiol J 2003;3:23–33.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Amiran Sh. Revishvili Permission Requests Google Scholar Articles by Bockeria, L. A. Articles by Grygoryev, O. Y. PubMed PubMed Citation Articles by Bockeria, L. A. Articles by Grygoryev, O. Y. Related Collections Related Article