Pediatric pacemaker

Case contributed by Jeremy Jones

Presentation

Acute and profound cardiac decompensation. Pacemaker and mitral valve replacement several months previously. Septic.

Patient Data

Age: 6 months
Gender: Male
x_ray

ETT and NGT appropriately sited.  V-A ECMO.  MVR.  Pacemaker.

Cardiomegaly with left-sided air-space opacification consistent with infection or pulmonary edema (the latter being less likely given the unilaterality).  Small left sided effusion.

Annotated image

Normal appearance of the pacemaker with no fracture around the pin insertion point.

Case Discussion

When assessing a pacemaker, look at lead position, but also look at the termination points where the leads are inserted.  If there is a fracture of the lead or it has migrated out of the termination point, the pacemaker will not work.

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