Thirty years of experience with epicardial pacing in children

Area of Science:

• Pediatric Cardiology
• Biomedical Engineering
• Cardiac Electrophysiology

Background:

• Epicardial pacing is often preferred for pediatric patients due to anatomical considerations.
• Long-term safety data for epicardial pacemakers in children is crucial for clinical decision-making.

Purpose of the Study:

• To assess the long-term safety and efficacy of epicardial pacemakers in a pediatric population.
• To identify risk factors associated with reintervention in children with epicardial pacing.

Main Methods:

• Retrospective review of 181 epicardial pacemakers and 260 electrodes implanted in 122 children between 1971 and 2001.
• Analysis of patient data over a total follow-up of 789 patient-years.
• Statistical analysis including univariate and multivariate risk factor identification for reintervention.

Main Results:

• Reintervention was required in 75 patients (61.5%) after a median of 5.0 years, primarily due to battery depletion (60%) and electrode issues (36%).
• Median sternotomy approach (RR 2.1, p=0.0256) and pacing indications other than atrioventricular block (RR 1.7, p=0.0314) were significant predictors of reintervention.
• One death was attributed to pacemaker dysfunction; overall mortality was low.
• Longevity of replacement pacemakers was comparable to initial implants.

Conclusions:

• Epicardial pacing demonstrates reliability and acceptable long-term safety in children, with low morbidity and mortality.
• A significant need for reintervention exists within five years, highlighting the importance of vigilant follow-up protocols.
• Further research into optimizing lead and battery longevity may reduce reintervention rates.