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Characteristics and results of epicardial pacing in neonates and infants
E Villain1, H Martelli, D Bonnet
1Service de Cardiologie Pédiatrique, Hôpital Necker Enfants-Malades, Paris, France.
Insights
Epicardial pacing effectively treats congenital complete atrioventricular block (CAVB) in infants. This study shows satisfactory outcomes with no pacing-related mortality and improved thresholds using steroid-eluting electrodes.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Congenital Heart Disease
Background:
- Congenital complete atrioventricular block (CAVB) in infants often requires pacing for symptomatic bradycardia or associated arrhythmias.
- Traditional pacing methods present challenges in pediatric populations, including lead dislodgement and generator issues.
Purpose of the Study:
- To evaluate the efficacy and safety of epicardial pacing in infants diagnosed with isolated CAVB.
- To assess long-term outcomes, including pacing thresholds, generator longevity, and complication rates.
Main Methods:
- Retrospective analysis of 34 infants (aged 1 day to 20 months) who underwent epicardial pacing between 1988 and 1998.
- Implantation via left thoracotomy or subxyphoid approach, with a preference for dual-chamber units in 22 patients.
- Use of steroid-eluting electrodes was noted to improve chronic ventricular thresholds.
Main Results:
- No operative mortality; three late deaths attributed to cardiomyopathy.
- Seven infants required reoperation for complications such as electrode displacement, infection, or exit block.
- Chronic ventricular thresholds were generally low (0.3-2 V), with improved thresholds noted with steroid-eluting electrodes.
- Pacemaker generators demonstrated longevity, lasting at least 5 years in 16 cases.
Conclusions:
- Epicardial pacing is a safe and effective treatment for infants with CAVB, yielding satisfactory long-term results.
- The deep generator placement minimizes risks of cutaneous erosion and allows for larger, longer-lasting devices.
- Steroid-eluting electrodes contribute to improved pacing thresholds and potentially better long-term outcomes.
Abstract:
The results of epicardial pacing in infants with isolated congenital complete atrioventricular block (CAVB) are reported. Thirty-four patients, aged 1 day to 20 months (22 patients < 1 month), were paced between 1988 and 1998. Thirty had bradycardia < 50 beats/min with symptoms in 12 patients, and 4 patients were paced because of associated ventricular ectopy or prolonged QT interval. In thirty cases, the electrodes were implanted through a left thoracotomy and connected to an abdominal generator; in four, the subxyphoid approach was preferred. Twenty-two children had dual chamber units. There was no operative death, but three patients died later of cardiomyopathy. Seven infants were reoperated for electrode displacement, infection, exit block, and pacemaker sensitivity. Chronic ventricular thresholds ranged from 0.3 to 2 V except in one case (4 V) and proper atrial sensing was lost in two cases. All children are doing well and the generator has lasted at least 5 years in 16 cases. In conclusion, epicardial pacing in infants with CAVB can be done with satisfactory results. There was no mortality in relation with pacing and thresholds have improved with the use of steroid-eluting electrodes. The deep location of the generator prevents cutaneous erosion and allows implantation of large units with a longer life duration.
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