日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

In Japan, there has yet to be a report of a leadless pacemaker (LPM) implant in a pediatric patient. We present a case of a pediatric patient who underwent LPM implantation for various reasons. A 12-year-old girl suffered rejection for heart transplantation that was performed for the treatment of dilated cardiomyopathy 2 years after the procedure. The rejection caused sinus node dysfunction syndrome, which necessitated pacemaker (PM) therapy. However, bilateral subclavian vein obstruction, invasiveness, and risk of device infection under immunosuppressive therapy made implanting either intravenous or epicardial PM difficult. The disadvantages of LPM, such as the limited number of reimplantation and the limited setting to ventricular single chamber pacing, were deemed insignificant because of the possibility of heart reimplantation and transient bradycardia attacks. Although vascular access was a concern because of the small body size, the LPM introducer sheath could be safely placed with adequate prior evaluation and gradual dilation of the femoral vein. There were no complications during or after the implantation procedure, and the LPM was able to work with bradycardia. A month later, we performed a catheter biopsy and successfully sampled the myocardium. With careful consideration of our indications, our experience suggested that LPM can be safe and useful in pediatrics.