Therapeutic Research

Abstract

Background：For pacing therapy in children, relative shortening of leads accompanying growth, frequent exchanges due to lead life, thrombotic vein occlusion are anticipated and epicardial leads are often chosen. Recently, reports using transvenous leads are also commonly found, but adaptation has no definite view. We report a case of a 9 – year–old child with complete atrioventricular block, a height of 110 cm and a weight of 16.1 kg, that was implanted with transvenous pacemaker without any complications. Case：A 9–year –old boy with adrenoleukodystrophy. During hospitalization for bronchial asthma attacks, bradycardia with heart rate（HR） 30 bpm was observed without induction and diagnosed as complete atrioventricular block with 12 lead electrocardiogram. Atropine infusion and continuous infusion of isoproterenol （ISP） did not improve the bradycardia, HR 30 bpm advanced bradycardia was occasionally repeated. An percutaneous pacing catheter was inser ted, followed by a permanent ransvenous pacemaker implantation. The generator was Advisa MRI （Medtronic Inc.）, the ventricular lead was 4.1 Fr SelectSecure MRI SureScan 3830（Medtronic Inc.）, screwed–in to the right ventricular septum. The setting was VVI （lower rate 80 bpm）, and with good postoperative course. Discussion：In this case, MRI –compatible pacemaker was preferred for evaluation of the original disease, and we wanted to avoid thoracotomy surgery and generator placement in the abdomen because gastrostomy was planned. Due to the growth disorder caused by the original disease, transvenous pacing device implantation was chosen. Conclusion：In patients with growth disorders, intravenous device placement may be an active choice.