In which patient population are epicardial leads most commonly employed?

Epicardial leads are most commonly employed in pediatric patients due to several important factors specific to this demographic. In infants and young children, the heart anatomy is different, and they may not have enough subcutaneous tissue for a standard transvenous approach. As a result, epicardial leads, which are placed directly on the surface of the heart, provide a more suitable and effective method for pacing in these younger patients. This technique can ensure adequate lead placement, especially in cases where traditional pacing methods may not suffice due to their smaller heart size or specific congenital conditions.

In contrast, while aging adults and patients with chronic heart failure may require pacing, the standard approach in these populations often involves transvenous lead placement. Similarly, in post-operative heart surgery adults, transvenous leads are typically favored unless there are special circumstances that necessitate the use of epicardial leads. Therefore, the use of epicardial leads is particularly prominent in pediatric patients, making this the apt choice.