Dual-chamber epicardial pacing in preterm and low birth weight infants with congenital complete atrioventricular block: a staged approach.

BACKGROUND

Congenital complete atrioventricular block (CCAVB) in preterm low birth weight neonates poses significant technical challenges for permanent pacemaker implantation. Epicardial pacing is generally preferred in this population; however, definitive implantation in infants weighing < 2500 g may be technically demanding. We evaluated the feasibility and safety of dual-chamber epicardial pacing in preterm low birth weight neonates with autoimmune-associated CCAVB.

METHODS

Eight preterm neonates weighing < 2500 g underwent epicardial pacing between April 2021 and May 2022. All patients initially received temporary epicardial pacing via a subxiphoid approach for rhythm stabilization. Permanent dual-chamber epicardial pacemaker implantation was subsequently performed following clinical optimization and weight gain. Procedural outcomes, pacing performance, ventricular function, and device-related complications were analyzed descriptively.

RESULTS

Temporary pacing was successfully established in all patients at a median postnatal age of 3 days (range, 0-12 days) and a median body weight of 2290 g (range, 1890-2440 g), without major complications. Permanent dual-chamber implantation was achieved in all cases at a median age of 18 days and a mean body weight of 2725 g. Electrical parameters, including sensing amplitudes and capture thresholds, remained stable throughout follow-up. One patient required ventricular lead repositioning due to persistent ventricular dysfunction, with subsequent functional improvement, while ventricular function remained stable or improved in the remaining patients. No device-related complications were observed during the follow-up period. The median follow-up duration was 24 months.

CONCLUSIONS

This study indicates that dual-chamber epicardial pacing is feasible and safe in selected preterm low birth weight neonates with CCAVB. When immediate permanent implantation is technically challenging, a staged approach may facilitate stabilization and subsequent definitive implantation with favorable early to short-term outcomes.