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Permanent epicardial pacing in neonates and infants less than 1 year old: 12-year experience at a single center
Junfei Zhao1, Ying Huang1, Liming Lei2
1Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
Permanent epicardial pacing in infants offers acceptable mid-term outcomes but carries risks of reoperation and death. Careful follow-up and lead selection are crucial for managing bradyarrhythmia in this population.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Permanent epicardial pacing (EPPM) is the standard treatment for bradyarrhythmia in neonates and infants.
- This study evaluates the mid-term outcomes of EPPM in this vulnerable patient group.
Purpose of the Study:
- To assess the safety and efficacy of epicardial permanent pacemaker implantation in neonates and infants.
- To identify factors influencing long-term outcomes, including reoperation rates and mortality.
Main Methods:
- Retrospective review of 31 neonates and infants undergoing EPPM implantation within their first year of life.
- Follow-up for up to 12 years, analyzing all-cause mortality and pacemaker reoperations using Kaplan-Meier and log-rank tests.
Main Results:
- 96.8% of patients survived to discharge with a median follow-up of 3.9 years.
- Lead failures occurred in 22.6% of patients, with a median lead longevity of 2.9 years.
- Generator reoperation rates were significant, with 52.4% freedom from reoperation at 5 years.
Conclusions:
- Mid-term outcomes for EPPM in neonates and infants are acceptable but associated with risks.
- Prognosis is influenced by regular follow-up, pacing lead type, and the presence of congenital heart disease.
Background:
Permanent epicardial pacing is the primary choice for neonates and infants with bradyarrhythmia. We reviewed mid-term outcomes after epicardial permanent pacemaker (EPPM) implantation in this age group.
Methods:
From Dec 1, 2008 to Dec 1, 2019, children who underwent EPPM implantation within the first year of life were included in our study. Patients were followed up for as long as 12 years, until Jun 11, 2021, for all-cause mortality and pacemaker reoperation. Kaplan-Meier and log-rank tests were used for analysis.
Results:
Of 31 consecutive patients [18 boys (58.1%) and 2 neonates (6.5%)] included in this study, 30 (96.8%) were discharged alive and assessed at a median follow-up of 3.9 years [interquartile range (IQR) 4.7]. The median age and weight of the patients were 156 days (IQR 217) and 5.3 kg (IQR 3.5), respectively, at the time of their operation. Twenty-five (80.6%) patients had congenital heart disease, and the main indication for pacing was postoperative atrioventricular block (AVB) in 21 (67.7%) patients. During follow-up, 3 (9.7%) patients died and there were a total of 9 pacing lead failures in 7 (22.6%) patients. The median longevity of leads (unipolar steroid-eluting) was 2.9 years (IQR 3.6). Freedom from lead reoperation was 90.3%, 72.0%, 65.5% and 49.1% at 1, 3, 5, and 8 years, respectively. The median longevity of the pacing generators was 3.3 years (IQR 2.8). Freedom from generator reoperation was 90.3%, 75.6%, 52.4% and 43.6% at 1, 3, 5 and 6 years, respectively.
Conclusions:
The mid-term outcome of EPPM implantation in neonates and infants was acceptable. Neonates and infants with EPPM implants face the risk of repeated reoperations and all-cause death. A patient's prognosis can depend on regular follow-up, type of pacing lead and the presence of congenital heart malformations, especially complex congenital heart disease.
