Children with Epicardial Pacemakers Face Risk of Cardiac Strangulation

An advisory notice has been issued in Canada for a rare, but potentially life-threatening risk of cardiac strangulation from epicardial pacemaker leads implanted in children, which may cause compression of the heart.

Health Canada issued an advisory on October 17, informing health care professionals and the public about the risk of epicardial pacemaker lead cardiac strangulation among children, stressing the importance of recognizing the symptoms of problems.

To date, there have been at least eight cases of cardiac strangulation reported by medical journals, including 2 deaths. Certain cases were recognized early enough that the children were successfully able to receive corrective surgery to replace the lead.

Epicardial pacemakers are connected to the heart through lead wires that monitor and correct a dysfunction in the heart’s firing mechanism. The problem arises from the epicardial lead, which can begin to compress the heart as the child grows. This may lead to strangulation of the heart.

Symptoms of potential heart compression from epicardial pacemaker leads may include chest pain, general fatigue, fainting, and signs of heart failure.

Health Canada indicated that children and parents of children known to have epicardial pacemaker leads should be aware of these symptoms, and contact their doctor if they notice any of them. If cardiac strangulation is diagnosed early, children are often able to undergo corrective surgery to replace the leads.