Permanent pacemakers in pediatric patients: novel and emerging technologies

Introduction: Though cardiac pacing has evolved substantially since its introduction, continued advancement is necessary to meet the needs of small patients and those with congenital heart disease. Areas covered: This narrative review summarizes current and emerging technologies for pediatric pacing based on a comprehensive search via PubMed and Google Scholar of peer-reviewed literature through April 2026. Technologies discussed include leadless pacemakers, pediatric-specific pulse generators for neonates, minimally invasive epicardial access techniques, and alternative pacing strategies for those with abnormal systemic venous anatomy. Additional areas of investigation include novel battery technologies such as energy harvesting, wireless power transfer, and experimental approaches to fetal pacing. Expert opinion: Although modern pacing systems have improved substantially over recent decades, current technologies do not meet the needs of many pediatric patients. Continued innovation in lead design, power sources, and minimally invasive implantation will be necessary to improve durability, reduce procedural burden and device-related morbidity, and expand pacing options for children with congenital and acquired conduction system disease. Given the relative rarity of conduction system disease in pediatric populations, multicenter collaboration is essential to support continued development of pediatric-specific technologies.