A new site for burying an implantable pacemaker in infants and young children is described. The Medtronic sutureless screw electrode is applied to the diaphragmatic surface of the heart through a transxiphoid approach. The unit is inserted in the abdominal wall between the transversalis fascia and the transversus muscle. The method is simple, taking approximately 30 minutes to complete. It avoids thoracotomy. The unit is well concealed and protected. The coils of the lead are relatively free from adhesions and allow for growth in the child.
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