Epicardial pacing outcomes in infants with heart block: Lead and device complications from a multicenter experience
Edward T O'Leary1, Shankar Baskar2, Audrey Dionne1
1Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Infants under 90 days receiving pacemakers for complete heart block face higher complication risks, particularly infections. Lead durability is comparable to prior pediatric studies.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Clinical Research
Background:
- Infants with complete heart block (CHB) require epicardial pacemaker (PM) implantation.
- Previous studies on epicardial pacing in infants had limitations due to small or mixed populations.
Purpose of the Study:
- To investigate patient and procedural factors associated with device complications in infants with CHB.
- To identify risk factors for adverse events following permanent pacemaker implantation in this population.
Main Methods:
- Multicenter, retrospective cohort study of infants receiving epicardial PMs for CHB (2000-2021).
- Primary outcome: time to device-related adverse events (lead failure, infection, exit block, coronary compression).
- Time-to-event analysis using Kaplan-Meier and Cox proportional hazards models.
Main Results:
- 174 infants received epicardial PMs; median follow-up was 2.1 years.
- 26 infants (15%) experienced device-related adverse events, with a median time to event of 0.6 years.
- Age ≤90 days at implantation was a significant risk factor (HR 7.02, P < .001), mainly due to pocket infections. 5- and 10-year lead failure rates were 7% and 17%.
Conclusions:
- Device complications impact 15% of infants with CHB receiving permanent pacemakers.
- Younger age (≤90 days) at implantation is a key risk factor, particularly for infectious complications.
- Epicardial lead durability in this cohort is consistent with previous pediatric findings.
Background:
Infants with complete heart block (CHB) require epicardial pacemaker (PM) insertion. Prior studies described epicardial pacing outcomes in infants and children, although they were limited by small or heterogeneous populations.
Objective:
This study aimed to explore patient- and procedure-level associations with device complications in infants with CHB who received a permanent PM.
Methods:
This was a multicenter, retrospective cohort study including infants receiving an epicardial PM between 2000 and 2021 for CHB. The primary outcome was time to device-related adverse event: lead failure requiring revision; pocket infection; exit block requiring increased pacing output; or lead-related coronary artery compression. Time-to-event analysis was performed by the Kaplan-Meier method with a multivariable Cox proportional hazards model.
Results:
There were 174 infants who received an epicardial PM (282 bipolar, 39 unipolar leads) for CHB. Median age and weight at PM were 93.5 days and 4.5 kg, respectively. Pacing indication was postoperative CHB in 63% and congenital CHB in 37%. The median follow-up was 2.1 years. The primary outcome occurred in 26 infants at a median time to event of 0.6 year. Age ≤90 days at PM implantation was the most significant risk factor for a device-related adverse event (hazard ratio, 7.02; P < .001), primarily driven by pocket infections. Lead failure occurred in 3% of leads with a 5- and 10-year freedom from failure of 93% and 83%, respectively.
Conclusion:
Device complications affect 15% of infants receiving a permanent PM for heart block. Age ≤90 days at PM implantation is especially associated with infectious complications. Epicardial lead durability appears similar to previously reported pediatric experiences.
