The heart is an organ that beats over 100,000 times a day, delivering the needed oxygen to the rest of the body. As a result, it is required that the heart maintain a steady and consistent beating pattern to supply the needed oxygen. This is achieved by the heart's natural pacemaker (also called the sinoatrial or SA node), which sends out small electrical impulses throughout the heart in a directed fashion along specialized conducting pathways. As these impulses reach different parts of the heart, they activate the muscle fibers and cause them to contract.  Through timed contractions, the heart beats and effectively pumps blood from within its chambers out into the blood vessels that lead to the rest of the body.
However, a small number of children have problems in the heart, either with the natural pacemaker or the conducting pathways. These problems may have been around since birth or have been caused by damage to the heart. For children with these problems, the electrical impulses from the natural pacemaker are usually not transmitted (or fully transmitted) throughout the heart, resulting in a much varied heart beat, which, in most cases, cannot pump an adequete amount of blood sufficient to maintain health in the child. Whether the heart beat is too fast or too slow (or even inconsistent), the effects as a result of this arrhythmia are often similar.
Luckily, this problem can be remedied through the use of an artificial pacemaker. This pacemaker is a small electrical device that is implanted within the body and can augment or even replace the function of the heart's defective pacemaker. It generates electrical impulses that reach the parts of the heart that are not receiving natural impulses, activating the muscles in that region and forcing them to contract in a timely manner in conjunction with the rest of the heart. 
Conditions Requiring a Pacemaker:
Premature Atrial Contraction (PAC) and Premature Ventricular Contraction (PVC):
Although there are arrhythmias that don't pose a significant threat to a person's health, there are some that can be very dangerous and would indicate a serious problem. It is imperative that you contact your doctor should symptoms arise. [2,3]
Once the procedure is complete, the child will be taken to the recovery room where he or she will undergo several hours of recuperation. Upon your child waking up, you will be allowed to join him in the room. The use of minimally invasive techniques have allowed for shorter hospital stays and quicker recovery times, often allowing the patient to return home the following day. During this time, the pacemaker will be checked for functionality, and the child's heart rhythm will be monitored. There will also be a transtelephonic transmitter and instructions on its use will be given, which will enable the doctor to check the pacemaker through the telephone. Upon leaving, your child will be given a temporary ID card that has information about the pacemaker, date of implant, and physician who performed the implant. A permanent ID card will be sent within three months. [6,7]
There are many precautions and restrictions associated with having a pacemaker, of which are mentioned below:
Once the wound is healed,there are several other precautions that your child must take [4,8,9]:
Generally, children with pacemakers should be able to resume the same activities that they are used to. However, a word of caution remains: when involved in physical activities, avoid receiving a blow to the area containing the pacemaker, as this may affect its functioning. As a result, contact sports are not recommended. If you are unsure of which activites your child can participate in, contact your child's doctor. [1,7]
It is also critical that a complete pacemaker check be done six weeks after implantation. During this appointment, adjustments will be made to the pacemaker that will prolong its life. Once this initial check up is complete, subsequent telephone check-ups should be done every 3 months to evaluate the battery function. 
Eight years ago, as a senior in high school, Michaela Gagne was crazy about sports. She lived for sports and was a three-sport athlete, and she had high hopes of competing in Division 1 athletics. However, with one fateful test, she was faced with the prospect of never playing sports again. At 17 years of age, Gagne was diagnosed with Long QT syndrome, a heart disorder characterized by irregular, fast heart beats. This disorder frequently goes undetected and its first symptom in most cases is sudden death.
She was fitted with an ICD in her freshmen year at the University of Massachusetts at Amherst, which allowed her to play competitive soccer again in intramurals. However, she continued competing in pageants as well and became a spokesperson for the American Heart Association. It was with this work that she spoke of at the Miss Massachusetts pageant and won.
While she ultimately did not win the Miss American contest, Gagne considers the opportunity to talk about cardiac issues a reward in itself. For her, the scar from the surgery serves as a physical reminder of what she went through. Despite not being able to participate heavily in sports, she remains as a national spokesperson for the American Heart Association, of which she takes great pride in being a part of.
Though she hasn't actually had an arrhythmic episode, it could arise from intense emotion or physical exertion. As a result, she has to constantly monitor the status of the ICD, to ensure that it has enough battery life, which often lasts five to seven years and can be easily replaced.
Gagne now has two devices, one of which is implanted in her chest- the original is engraved with her name and is carried around in her purse as a personal good luck charm. [10,11,12,13]
Despite the benefits of artifical pacemakers, the downsides of it are that children quickly outgrow the device and the pacemaker requires repeat operations ever 5-10 years, which in children would amount to at least 5 to 6 operations in their lifetime.
According to new findings from Children's Hospital Boston, scientists have developed a method of growing skeletal muscle cells that transmit heart electrical signals when implanted within rat hearts. If applicable to humans, this would serve wonders as it offers innate advantages over artifical pacemakers. One of the benefits of this biological alternative is that it would grow with the child, which would eliminate the need for repeat operations and would enable the child greater freedom in life, eliminating most of the restrictions that come with implanting an artificial pacemaker.
At the moment, this therapy method is still far from finished. The heart is complex muscle and its operation is even more complex. Before this method can progress further, it must first mimic the normaly time delay of the AV node, an important aspect of normal heart function. In addition, this therapy must be applied to larger animals, especially those who resemble humans, since it is humans that will ultimately benefit from this.
Nevertheless, the field of preserving heart function has advanced greatly over the years. From medications to pacemakers to ICDs to biological therapies, much has been achieved that has allowed us to further extend the lives of many children and adults. Ultimately, a biological approach to heart pacing would be superior to an artificial approach, but until that time comes, pacemakers and ICDs offer children a sufficient, and often satisfying, quality of life.