Child w/ PM Voltage problems

My granddaughter (9yrs old, HLHS, Complete AVSD, 7 yrs post Fontan) has had a PM for 2 1/2 yrs. She started out at a very low voltage of .25. Five months ago, they had to increase the voltage. She's had increases at each check up since then, and today they increased her another .25 for a total now of 1.5. She has two leads, but they are just doing atrial pacing. She is paced 50% of the time.
My question is, does this just sound like a bad or misplaced lead, or could it possibly be that her heart is just not responding as it should and getting progressively worse?
The doctor doesn't want to go over 2 volts because of her age. He has mentioned the possibility of replacing the lead.

UPDATE: We just saw her PM doctor last week. The voltage had to be increased again.   In one years time, she has gone from 0.25 to 3.75. We quizzed the doctor and got no real information. He said he wasn't concerned because she had stabilized. Having to more than double the voltage from 1.5 to 3.75  since the last increase seven months ago looks more like a trend than stabilization. Anyone have any thoughts?  I heard the tech say my granddaughter was "falling out" at 1.75.  The doc said they like to keep it set at double what they need. I also heard something about a "short stem QRS". 

1 Comments

leads in kids

by Tracey_E - 2016-04-27 12:04:47

It's more likely the lead is the issue than her heart not responding. Kids go through leads a lot more quickly than adults do, partially because of how they're placed and partially because kids are much more active as well as constantly growing. I'm no expert, but I would think this is just typical for a paced kid, not a bad placement or a sign of a bigger problem.

Increasing the voltage decreases the battery life. As long as the lead is functioning, they'll probably just watch it until the battery needs replaced, then do it all at once.

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