Introduction: Indications for permanent pacing in pe-diatric patients have been difficult to define due to the lack of data from controlled studies and trials. However, the 2008 guidelines of the American College of Cardiology/American Heart Association/ Heart Rhythm Society (ACC/ AHA/ HRS) and the 2013 ESC Guide-lines on cardiac pacing and cardiac resynchronization therapy include indications for implantation of pace-makers in children.
Objective: Starting from real clinical situations we have proposed to analyze how current children pacing recommendations respond to diversity and complexity of pediatrics patients, considering the combinations of congenital and acquired disease.
Results: The main indication for pacing in childhood is symptomatic bradycardia, most commonly due to complete heart block Sinus node dysfunction with or without atrioventricular conduction disturbances, spe-cifically when related to congenital heart disease, is a less frequent indication to implant a pacemaker system. Conclusions: The implantation of cardiac pacing de-vices in children and young adults can be challenging and different from the adult population due to their smaller size, their longer life expectancy, and anatomi-cal variations associated with congenital heart defects.