A safe and effective method for pacemaker implantation in children Axillary vein puncture for device implantation and use of 4F catheter- delivered pacing leads in children

Background: Contrast-guided axillary vein puncture has gained popularity for pacemaker and implantable cardioverter defibrillator (ICD) implantation in adults owing to its low risk profile, and could be an alternative to subclavian vein puncture, which is commonly performed in children. The Medtronic 3830 lead is a 4.1F lumenless catheter-delivered lead which may be particularly well-suited for use in the paediatric population because of the reduction in intravascular material and possibility for selective-site lead placement in complex anatomies. Methods: Data on paediatric patients at our institution aged <15 years who underwent transvenous device implantation using contrast-guided axillary vein puncture were retrieved. Contrast-guided axillary vein puncture was performed in all patients as the primary approach under general anaesthesia. Results: We retrieved data from 15 patients (7 males), aged 7.7 ± 4.1 yr (range 2–15 yr) at the time of intervention, and weighing 23.0 ± 9.6 kg (range 11.3–38.0 kg). Axillary vein puncture was successful in all patients. We placed 9 right atrial leads, 13 right ventricular pacing leads, 1 right ventricular ICD lead and 1 coronary sinus lead. A 3830 lead was successfully implanted in all 12 patients in whom this lead was intended. There were no procedure-related complications and lead electrical parameters were within normal limits in all patients after a mean follow-up of 13 months. Conclusion: Contrast-guided axillary vein puncture is a safe and effective method for pacemaker implantation in children. Furthermore, the thinbodied 3830 lead provides stable pacing parameters while reducing the bulk of intravascular material.