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Epicardial Pacemaker in Neonates and Infants: Is There a Relationship Between Patient Size, Device Size, and Wound
Servet Ergün1, Hasan Candaş Kafalı2, Serhat Bahadır Genç3
1Department of Pediatric Cardiovascular Surgery, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, İstasyon Mahallesi İstanbul Caddesi Bezirganbahçe Mevki, 34303, Istanbul, Turkey. drservetergun41@gmail.com.
Insights
Epicardial pacemaker implantation in infants showed a low complication rate (9%). Device type and patient size did not significantly impact outcomes, supporting dual-chamber pacemaker use for AV synchronization.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Epicardial pacemaker (PM) implantation is a critical intervention for neonates and infants with cardiac conditions.
- Understanding PM-related complications is essential for optimizing patient care and device selection.
Purpose of the Study:
- To investigate complications following epicardial pacemaker implantation in infants.
- To analyze the relationship between patient size, device characteristics, and complication development.
Main Methods:
- Retrospective evaluation of 55 infants (<1 year) who underwent epicardial PM placement (May 2010 - July 2018).
- Complications defined as rehospitalization-requiring events (e.g., wound issues, infection, device revision).
- Patients categorized by weight (<3 kg, 3-5 kg, >5 kg); single- vs. dual-chamber devices compared.
Main Results:
- Nine percent (5/55) of patients experienced 18 PM-related complications.
- No statistically significant difference in complication rates was found across weight groups (p>0.05).
- Single-chamber vs. dual-chamber device implantation did not significantly affect complication development (p>0.05).
Conclusions:
- Epicardial PM implantation in infants has a low complication incidence.
- Patient size and device type (single vs. dual chamber) did not significantly influence complication rates.
- Findings support the use of dual-chamber pacemakers for improved atrioventricular synchronization in pediatric cardiac conditions.
Abstract:
We aimed to investigate the complications after epicardial pacemaker (PM) implantation in neonates and infants and their relationship with factors such as device size and patient size. Between May 2010 and July 2018, 55 patients under 1 year of age who underwent epicardial PM placement were retrospectively evaluated. PM-related complications requiring rehospitalization were determined as wound site problems requiring surgical intervention, battery pocket infection, battery pocket dehiscence without infection, PM removal, relocation of the PM system, and replacement of the PM system with another system. The patients were divided into three groups: < 3 kg, 3-5 kg and > 5 kg. Fifty-five patients underwent PM implantation, 43 (78.2%) because of postoperative atrioventricular block (AVB), 10 (18.2%) because of congenital AVB, and two (3.6%) with diagnoses of c-TGA and AVB. Five (9%) patients incurred 18 complications. No statistically significant difference was observed in complication development between the groups (p > 0.05). Single- or dual-chamber device implantation did not affect complication development (p > 0.05). Despite the role of factors such as low weight, low age, and device volume in the development of wound complications, the relationship between these factors and complications is not statistically significant. Therefore, our results are encouraging in terms of the use of dual-chamber PMs instead of single-chamber ones in heart diseases in which AV synchronization is important.
