Implantation of a Permanent Pacemaker in a Premature Infant

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RESUMO

In March 1984 we implanted a permanent, dual-chambered pacemaker in a 2.1-kg premature male infant suffering from congenital atrioventricular block, with an atrial rate of 170 beats per minute, a ventricular rate of 40 beats per minute, and ectopic ventricular escape beats. Through a left anterolateral thoracotomy, we implanted electrodes on the left atrium and left ventricle; through a second incision, in the left flank, we gained access to the retroperitoneal space by finger dissection. The electrodes were then guided through the diaphragmatic sulcus into the retroperitoneal space for attachment to a dual-chambered pacemaker permanently placed in the lumbar region. Our patient was discharged in good condition 23 days after operation and continues, despite some difficulties in establishing optimal pacemaker settings, to enjoy excellent clinical status 55 months after implantation, having moved progressively through pacemaker settings for VVI, DVI, and DDD modes, as his heart has improved.

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