Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial?

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Massimo Stefano Silvetti1, Fabrizio Drago, Duccio Di Carlo

  • 1Unità Operativa di Aritmologia/Syncope Unit, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica Bambino Gesu` Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, 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
|February 27, 2013
PubMed

Insights

Pediatric cardiac pacing in congenital heart defects (CHDs) is challenging. Endocardial systems demonstrate superior long-term outcomes compared to epicardial systems, with younger implant age being a risk factor for complications.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Electrophysiology
  • Congenital Heart Disease

Background:

  • Cardiac pacing in children with congenital heart defects (CHDs) presents unique challenges.
  • Limited research exists on long-term outcomes of pacing in this population.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of endocardial versus epicardial pacing systems in pediatric patients with CHDs.
  • To identify risk factors for pacing system failure and complications in this cohort.

Main Methods:

  • Retrospective analysis of 287 pediatric patients with CHDs who underwent cardiac pacing between 1982 and 2008.
  • Comparison of outcomes between endocardial (Endo) and epicardial (Epi) pacing systems.
  • Multivariate analysis to identify predictors of pacing system failure.

Main Results:

  • Endocardial systems showed significantly lower failure rates (13%) compared to epicardial systems (40%) over a median follow-up of 5 years.
  • Younger age at implantation and the use of epicardial systems were associated with a higher risk of pacing system failure.
  • Steroid-eluting leads demonstrated a lower risk of malfunction, particularly in endocardial placements.

Conclusions:

  • Cardiac pacing in pediatric patients with CHDs yields satisfactory long-term results.
  • Endocardial pacing systems offer significantly better long-term outcomes than epicardial systems in this population.
  • Younger age at implantation is a significant risk factor for long-term pacing complications.
Abstract

Keywords:
Cardiac pacingChildrenCongenital heart defectsEndocardial pacingEpicardial pacingPacing complication

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