Leadless pacing in young patients.

Leadless pacing has been established as an effective and safe therapy. The majority of published data relates to an older population. However, this therapy may be particularly attractive for a younger (<40 years) population where the complications of transvenous devices can be enhanced. These include having leads in the vasculature for a longer period of time and the need for more generator changes over a longer time frame that may increase the rate of complications, e.g. infection. There is increasing evidence that leadless pacing is safe and effective in a younger population that may include specific patient groups such as those that require infrequent pacing, e.g. cardioinhibitory vasovagal syncope. Additionally, leadless pacing may be particularly suited to patients with adult congenital heart disease where conventional access with transvenous devices may be challenging. There are also some other groups such as neuromuscular disorders associated with conduction system disease that may benefit. The paediatric population is a further group that offers many challenges for pacing and so may be considered for leadless pacing. There is an increasing evidence base for the use of a superior jugular approach in this population rather than the conventional femoral approach. Further evidence to support leadless pacing would be enhanced with prospective randomized controlled studies in the population under the age of 40 years.