Epicardial Use of Medtronic 3830 Lead in Pediatric Cardiac Resynchronization Therapy with Elevated Thresholds

ABSTRACT Background Epicardial pacing is standard in children, but conventional leads often fail due to high thresholds, fractures, or poor sensing after multiple surgeries. Case A 10‐year‐old with restrictive cardiomyopathy and prior mitral valve replacement presented with loss of capture from fractured epicardial leads. Redo sternotomy attempts with conventional leads produced thresholds up to 8.0 V. A Medtronic SelectSecure 3830 lead was implanted epicardially, achieving improved thresholds (2.7 V → 1.1 V) and stable cardiac resynchronization therapy (CRT) pacemaker function. At 2 months, thresholds and impedances remained low and stable. Conclusion Epicardial Medtronic SelectSecure 3830 lead implantation may be a feasible alternative in complex pediatric redo cases.