Applications of pacing strategies in neonates and infants.

Pacing in neonates and infants continues to be challenging due to size constraints, growth potential, and the need for life long pacing. Indications for permanent pacing in pediatric patients have been difficult to determine due to the lack of data from controlled studies and multicenter trials. Temporary pacing has been useful to restore cardiac output in pediatric patients quickly and efficiently. Methods of temporary pacing include transcutaneous, transesophageal, transvenous, and epicardial. Permanent pacemaker implantation can be accomplished by transvenous or epicardial approaches, but the use of transvenous pacing in neonates and infants offers no advantages over epicardial pacing. Transvenous pacing in infants is often prohibitive due to size and growth constraints as well as the subsequent risk of skin erosion and venous thrombosis. Smaller pulse generators, multiprogrammable features, and steroid-eluting epicardial leads are a few of the technological advances that have made pacing in neonates and infants easier and safer. Data supporting the use of pacing systems in very young patients are sparse. Pacing 'indications' should be viewed as guidelines until such data can be accumulated.