Grand Rounds: Leadless Pacemakers in Pediatrics: Is It Time?

Objectives (Educational Content) :

1. Explain the clinical indications for cardiac pacing in pediatric patients with heart block and compare the advantages and limitations of epicardial, transvenous, and leadless pacemaker systems

2. Analyze the current pediatric evidence for leadless pacemaker safety and efficacy — including the PACES Transcatheter Leadless Pacemaker Registry — and recognize the gaps that limit generalizability across the pediatric age and size spectrum.

3. Assess the challenges of long-term device management in pediatric patients, including the evidence for and against chronic retrieval of leadless pacemakers and the implications of device abandonment in a growing heart.

Target Audience:

General pediatricians, family physicians, nurse practitioners, physician assistants, social workers, psychologists, and nurses.

Identified Gap:

Clinicians caring for pediatric patients who require permanent cardiac pacing face challenges in appropriately selecting and managing leadless pacemakers due to limited pediatric-specific evidence, evolving technology, and uncertainty regarding long-term outcomes. As a result, there is variability in the evaluation of candidates for leadless pacing, interpretation of available safety and efficacy data, and decision-making around device retrieval versus abandonment. Education is needed to increase knowledge and competence in applying current evidence, comparing available pacing modalities, and developing long-term management strategies that optimize outcomes for pediatric patients.

Estimated Time to Complete the Educational Activity:

1 hour(s)

Expiration Date for CE/CME Credit:

07-30-2027

Method of Participation in the Learning Process:

The learner will view the presentation, successfully complete a post-test and complete an activity evaluation.

Evaluation Methods:

All learners must successfully complete a post-test, as well as an activity evaluation, to claim CE/CME credit.

Disclosure:

The speaker(s) has returned the disclosure form, indicating that there are no financial relationships with ineligible companies:  Stephen Manu, MD The following CME Committee/Planning Committee member(s) has the following financial relationships with ineligible companies to disclose: Merck - Maria Cristina Victorio, MD All financial relationships have been mitigated. All remaining CME and planning committee members have returned their disclosure forms, indicating that they have no financial relationships with ineligible companies. 

Accreditation Statement:

Children’s Hospital Medical Center of Akron is accredited by the Ohio State Medical Association to provide continuing medical education for physicians.

CHMCA designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit TM.  Physicians should only claim the credit commensurate with the extent of their participation in the activity.

Bibliography:

 1. Shah MJ, Borquez AA, Cortez D, McCanta AC, De Filippo P, Whitehill RD, Imundo JR, Moore JP, Sherwin ED, Howard TS, Rosenthal E, Kertesz NJ, Chang PM, Madan N, Kutalek SP, Hammond BH, Janson CM, Ramesh Iyer V, Williams MR. Transcatheter Leadless Pacing in Children: A PACES Collaborative Study in the Real-World Setting. Circ Arrhythm Electrophysiol. 2023 Apr;16(4):e011447. doi: 10.1161/CIRCEP.122.011447. Epub 2023 Apr 11. PMID: 37039017.

2. Removal of Tine-Based Leadless Pacemakers - Insights From a Large Multicenter Experience.Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology. 2026. Jurisic S, de Lavallaz JDF, Gasperetti A, et al.

3. Worldwide Chronic Retrieval Experience of Helix-Fixation Leadless Cardiac Pacemakers. Journal of the American College of Cardiology. 2025. Neuzil P, Exner DV, Knops RE, et al