Pediatric Epicardial Devices: Early and Midterm Outcomes

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Device Therapy

Background:

• Lead performance issues are a significant cause of device system failure in pediatric patients.
• Epicardial device implantation is an alternative to transvenous leads in children.

Purpose of the Study:

• To evaluate the early and midterm outcomes of epicardial device implantation in a contemporary pediatric cohort.
• To assess the safety and efficacy of epicardial device implantation in children, particularly those younger than 8 years old.

Main Methods:

• A retrospective analysis of 137 epicardial device implantations (40 pacemakers, 97 implantable cardioverter-defibrillators) in 116 pediatric patients from 2010 to 2019.
• Lead failure was defined as leads requiring repair, replacement, or abandonment due to mechanical or electrical issues.
• Kaplan-Meier analysis was used to determine freedom from device system failure.

Main Results:

• The mean age at implantation was 10 ± 5 years, with 34% of patients younger than 8 years old.
• Three-year freedom from device system failure was 80% overall and 88% for patients younger than 8 years old.
• The primary causes of device system failure were lead fracture (59%), lead dysfunction (15%), and lead dislodgement (15%).

Conclusions:

• Epicardial device implantation is a safe procedure with acceptable midterm outcomes in pediatric patients.
• This approach is an effective option for children younger than 8 years old.
• Continuous device surveillance is crucial for early detection of lead failure and timely intervention.