Viera Illíková, Robert Hatala
Cardiac pacing is a mainstay of bradycardia treatment in adults as well as paediatric population. Pacemaker implantations in children represent less than 1 % of all implantations, but they are associated with several highly specific issues. One of them is the body size and growth of the child with a subsequent question about implantation techniques and repeated electrode exchange, or higher mobility of the child associated with higher risk of electrode damage. Pacemaker implantation in a child usually implies the necessity for chronic pacing for the entire rest of life, so it carries besides the risk of various complications also the risk of pacing-induced cardiomyopathy. That is the reason why there are many studies in the last years searching for optimalisation of pacing sites. Complications of cardiac pacing associated with electrode system are probably higher in children than in adults, although there are no comparative studies. Infection of the pacing system, venous obstruction or complications of repeated electrode explantations are among the most serious complications. Congenital or postoperative complete AV block is the most common indication for pacemaker implantation in children. Specific issue is a postoperative sinus node dysfunction in children with congenital heart disease after cardiac surgery. In the last decade there are also efforts to find a role of cardiac resynchronization therapy in children. In spite of more heterogenity in the paediatric heart failure population, available studies demonstrate a comparable benefit of cardiac resynchronisation also in children. Development of pacemaker technology during last decades is very rapid, with remarkable downsizing of impulse generators and progressively thinner pacing leads. This progress has made application of cardiac pacing in children easier although no dedicated paediatric pacing systems exist. The recent availability of MRI compatible pacing system is of fundamental importance, especially for children with congenital heart disease.