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Trends in pediatric cardiac pacing
V Rao1, W G Williams, R H Hamilton
1Division of Cardiovascular Surgery, Sunnybrook Health Science Centre, Hospital for Sick Children, Toronto, Ontario.
Insights
Pediatric cardiac pacing trends show increased use of endocardial leads and a rise in sick sinus syndrome diagnoses. Lead type and diagnosis did not impact survival rates in children over 31 years.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Cardiac Electrophysiology
Background:
- Cardiac pacing in children has evolved significantly over decades.
- Technological advancements influence pacemaker implantation strategies.
- Understanding long-term outcomes is crucial for pediatric cardiac care.
Purpose of the Study:
- To retrospectively analyze 31 years of pediatric cardiac pacing experience.
- To identify changing trends in pacemaker implantation in infants and children.
- To evaluate outcomes related to lead type and diagnosis.
Main Methods:
- Retrospective review of 397 children (under 18) undergoing initial pacemaker implantation (1962-1992).
- Data collected from a dedicated pediatric pacemaker follow-up clinic.
- Long-term follow-up (mean 6.5 years) assessed outcomes.
Main Results:
- Significant increase in endocardial versus epicardial lead use over time (P < 0.001).
- Significant rise in sick sinus syndrome as a primary diagnosis (P < 0.001).
- No significant difference in survival or exit block frequency between lead types or diagnoses.
Conclusions:
- Pediatric cardiac pacing guidelines are dynamic, influenced by lead technology.
- Endocardial leads are increasingly preferred in pediatric pacemaker implantation.
- Continued research is needed to optimize pacing strategies for children.
Objective:
To review retrospectively a 31-year experience with pediatric cardiac pacing at the University of Toronto, with an emphasis on the changing trends in pacemaker implantation in infants and children.
Data Source:
Data were obtained from the pediatric pacemaker follow-up clinic at The Hospital for Sick Children, Toronto, Ontario or from the referring pediatric centre. Follow-up was normally continued until the death of the child or referral to an adult hospital at age 18 years.
Patient Selection:
The study comprised 397 children (under 18 years of age) who underwent initial pacemaker implantation at The Hospital for Sick Children between January 1962 and December 31, 1992. Follow-up was 99% complete (five children lost) and ranged from one month to 32 years (mean 6.5 years).
Data Synthesis:
The use of endocardial versus epicardial leads increased significantly over time (P < 0.001). In addition, significantly more children receiving pacemakers had sick sinus syndrome (P < 0.001). No difference in survival was found between children paced by endocardial versus epicardial leads or between children paced for sick sinus syndrome versus atrioventricular block. The frequency of exit block, by lifetable analysis, did not differ between children who received epicardial versus endocardial leads.
Conclusions:
Guidelines for permanent pacemaker implantation in children continue to evolve as developments in lead technology alter trends in pediatric cardiac pacing.
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