Epicardial Use of Medtronic 3830 Lead in Pediatric Cardiac Resynchronization Therapy with Elevated Thresholds.

BACKGROUND: Epicardial pacing is standard in children, but conventional leads often fail due to high thresholds, fractures, or poor sensing after multiple surgeries. CASE: A 10-year-old with restrictive cardiomyopathy and prior mitral valve replacement presented with loss of capture from fractured epicardial leads. Redo sternotomy attempts with conventional leads produced thresholds up to 8.0 V. A Medtronic SelectSecure 3830 lead was implanted epicardially, achieving improved thresholds (2.7 V → 1.1 V) and stable cardiac resynchronization therapy (CRT) pacemaker function. At 2 months, thresholds and impedances remained low and stable. CONCLUSION: Epicardial Medtronic SelectSecure 3830 lead implantation may be a feasible alternative in complex pediatric redo cases.