Epicardial Implantation of a Micra™ Pacemaker in a Premature Neonate with Congenital Complete Heart Block.

Pacemaker implantation in neonates can be challenging due to their small size. Even pulse generators adapted for pediatric patients, such as the Microny device (Abbott, Chicago, IL, USA), are proportionately large in comparison to the size of the smallest newborns. Due to anatomic considerations, such as small vascular and ventricular sizes, leadless pacemakers and transvenous implantation in the youngest neonatal population remain unsuitable. Even so, the desire for leadless devices has prompted the industry to create the smallest pacemakers available. Adapting the smaller Micra™ transcatheter leadless pacing system (Medtronic, Minneapolis, MN, USA) for an epicardial pacing application may be advantageous to the smallest patients. This case illustrates the use of a Micra™ device modified with a header block to serve as the pulse generator in a ventricular epicardial pacing system for a 1-day-old, 2.68-kg patient with complete heart block.