Temporary transvenous atrioventricular synchronous pacing using a single lead in a pediatric patient

For pediatric patients with significant bradycardia, pacing has become a vital therapy. Owing to small patient size and anatomic limitations from structural heart disease, epicardial pacing systems may be required, though complications are well described.1, 2, 3, 4, 5 Significant morbidity and potential mortality may result from the resulting bradycardia after a complication. Patients with significant hemodynamic derangement in the absence of effective pacing require consideration of temporary pacing until a permanent system can be implanted. Various methods of temporary pacing using transvenous approaches are published.6, 7, 8, 9, 10 Research investigating these approaches in children is lacking.11 For patients with heart block who require atrioventricular (AV) synchrony to maintain effective cardiac output, temporary pacing with a single ventricular pacing lead will be inadequate and requires a second lead to provide atrial sensing. Alternatively, the use of a ventricular lead capable of providing atrial sensing (VDD) has the potential for the same hemodynamic benefit with use of a single lead.12,13 In this report we describe the novel use of a VDD pacing lead attached to an externalized generator in a pediatric patient with structural heart disease contrasted with a case of a single ventricular lead not capable of atrial sensing (VVI).