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Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants

Massimo Stefano Silvetti1, Fabrizio Drago, Antonella De Santis

  • 1Department of Pediatric Cardiology, Ospedale Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Roma, Italy. silvetti@opbg.net

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|April 26, 2007
PubMed

Insights

Endocardial pacing is safer and more effective than epicardial pacing in infants. This study suggests endocardial pacing may be the preferred choice for pacemaker implantation in this population.

Area of Science:

  • Pediatric Cardiology
  • Biomedical Engineering
  • Cardiac Electrophysiology

Background:

  • Pacemaker (PM) implantation in infants involves either endocardial (ENDO) or epicardial (EPI) systems.
  • The optimal pacing strategy for infants remains debated, impacting long-term outcomes.

Purpose of the Study:

  • To compare the safety and efficacy of ENDO versus EPI pacing systems in infants.
  • To identify factors influencing pacemaker system success in pediatric patients.

Main Methods:

  • Retrospective analysis of 56 infants (< or = 1 year) who received PM implantation between 1992 and 2004.
  • Evaluation of pacing system failures, lead complications, and patient characteristics, including congenital heart defects (CHDs).

Main Results:

  • Epicardial pacing was associated with a significantly higher risk of system failure (21-fold increase) compared to endocardial pacing.
  • Lead failure rates were higher for EPI (atrial 18%, ventricular 24%) than ENDO (ventricular 5%).
  • Patients with complex CHDs also showed a reduced success rate with EPI pacing.

Conclusions:

  • Single-lead, VVIR ENDO pacing demonstrated superior efficiency and safety in infants compared to EPI pacing.
  • ENDO pacing may be the preferred method for pacemaker implantation in infants, though further research with larger cohorts and longer follow-up is warranted.
Abstract

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