Management of phrenic nerve stimulation caused by epicardial pacemaker leads in children

To find a suitable site with good sensing and low pacing thresholds, it may be necessary to place an epicardial pacemaker lead in close proximity to the phrenic nerve. To prevent phrenic stimulation, a silastic patch can be sewn over the area of the pacing electrode to shield it from the nerve. This simple technique prevents diaphragm contraction and has not interfered with long-term pacemaker lead function.