Use of an atrial loop has been proposed as a means of extending the longevity of endocardial pacing systems in small children who require ventricular pacing. A few reports have demonstrated the effectiveness of this method at reducing the number of interventions in infants and small children, but there is little reported experience in neonates. Permanent endocardial ventricular demand pacing was performed in a 3.4-kg neonate. The generator was placed in a prepectoral pocket and a redundant loop of lead was left in the atrium to cater for further growth. At 32 months he weighs 13.6 kg and the loop has uncoiled leaving additional lead slack for further growth.