Background Pediatric pacemaker implants comprise <1% of all pacemaker implants. Pacemaker therapy in children involves unique issues regarding patient size, growth, development, and possible presence of congenital heart disease. This chapter reviews unique aspects of pediatric pacemaker implantation and follow-up, with particular attention to the difficulties encountered with smaller children and patients with coexistent congenital heart defects.Methods & ResultsWe aim in this study to follow Pediatric patients who underwent permanent pacemaker insertion pro- and retrospectively.Between January 2001 & December 2010, 91 pediatric patients (mean age, 3.2 (±2.4) years, range, 16 days-12 years; mean body weight, 13.25kg (±6kg) ranging from 3 to 42kg) underwent permanent pacemaker implantation. Indications were sinus node dysfunction and atrio-ventricular block following surgery for congenital heart disease (59.35%), or congenital heart block in 34.1%, congenital sinus node dysfunction in 5.5%, inappropriate sinus bradycardia in 1.1%. Pacing was purely ventricular (96.18%), or atrioventricular synchronized (2.91%). Transvenous pacing was established in 89.3%, Epicardial in 10.7% patients. The site of pacing was the RVA (right ventricular apex) in 62%, followed by the RVOT in 24.3%, LV pacing was performed in 3.9%. In patients with LTGA pacing leads were inserted in the morphological LV (i.e. the right sided ventricle) in 5.8%.70% of the patients in this study had abnormal echocadiographic findings prior to pacemaker insertion. Among those with congenital heart block& congenital sinus node dysfunction 43.24% had abnormal echocadiographic findings the most common of which was L-TGA.72% had a non-complicated course. 3 patients died, 3 patients (10.3%) had lead malfunction. The total percentage of implant related complications in the study population was 3.8%. 7 patients required PM revision due to PM-related complictios 3 patients with postoperative complete heart block ( 5.7 % of postoperative patients with CHB ) regained sinus rhythm > 1year following pacemaker insertion. A statistically significant improvement in the LV dimensions post-pacing ( 11 patients) vs pre-pacing (34 patients) was reported, (P <0.001). A statistically significant improvement in LV dimensions was recorded in patients with endocardially inserted pacemaker leads , (P< 0.001), while no statistically significant difference was found between the pre-pacing & post-pacing presence of LV dilatation in patients with epicardially inserted pacemaker leads (P>0.05). Also significantly wider QRS complexes were recorded in epicardial group than the endocardial group (the mean & median QRS width are 0.13 & 0.12 sec respectively Vs 0.10 & 0.10 sec) (P 0.003). T the mean values of ventricular lead impedence were significantly higher in epicardially than endocardially paced patients initially then later on (P 0.021).