Repeated epicardial lead dislodgement in a child with trisomy 21 and complete atrioventricular block: A case report.

UNLABELLED: Lead dislodgement is a rare complication of epicardial leads, which are generally chosen for pacemaker implantation in pediatric patients. Here, we report the case of a 12-year-old girl with trisomy 21 and a complete atrioventricular septal defect. The patient required epicardial pacemaker implantation; however, the epicardial left ventricular lead unexpectedly dislodged twice. This report discusses the potential causes and outlines our management strategy. LEARNING OBJECTIVE: Age, body size, growth-related changes, lifestyle, and durability complicate pacemaker implantation in children. Therefore, epicardial leads are commonly used for pacemaker implantation. Epicardial leads are not limited by body size or disease, and venous obstruction is not an issue; however, they are more invasive. Pacemaker implantation in pediatric patients with congenital heart disease requires meticulous consideration of patient-specific anatomical and physiological factors. Careful preoperative discussions among pediatric and adult cardiology teams, as well as cardiovascular surgery teams, are essential to optimize patient outcomes.