Original article
Pediatric cardiac
Permanent Epicardial Pacing in Pediatric Patients: 12-Year Experience at a Single Center

https://doi.org/10.1016/j.athoracsur.2011.09.072Get rights and content

Background

Permanent cardiac pacing is not often done in children, and when done is usually accomplished through epicardial pacing. We reviewed a 12-year experience with the implantation of epicardial pacemakers by our clinical group.

Methods

Fifty-three patients who underwent their first implantation of an epicardial pacemaker before the age of 18 years and between 1997 and 2009 were included in our study. The mean age of the patients at the time of first pacemaker implantation was 5.7 ± 4.8 years. Indications for pacemaker implantation included postoperative or congenital atrioventricular block and sinus node dysfunction. The patients underwent 105 operations for the replacement of pacemaker pulse generators and 75 operations for the replacement of pacemaker leads. The most commonly used generator mode was the rate-responsive accelerometer-based (DDDR) mode, which was used in 40.9% of the patients. We used more non-steroid-eluting leads (70.1%) than steroid-eluting leads (29.1%).

Results

The overall duration of follow-up in the study was 8.0 ± 4.5 years (range, 2.1 months to approximately 17.0 years). Freedom from the need for generator replacement was 98.0%, 60.7%, and 11.1% at 1, 5, and 8 years, respectively. A tendency toward early generator exhaustion was observed among younger patients (p = 0.058). The generator mode used for pacing did not significantly affect generator longevity. Freedom from the need for lead replacement was 98.3%, 83.8%, and 63.6% at 1, 5, and 10 years, respectively. The mean longevity of the leads used in the study was 10.8 ± 0.8 years. Neither patient age at the time of lead implantation nor type of lead significantly affected lead longevity.

Conclusions

Lead longevity was sufficiently long and did not vary significantly according to type of lead. Generator longevity was not affected by lead type, generator mode, or patient age at the time of pacemaker implantation.

Section snippets

Patient Characteristics

Fifty-three patients under the age of 19 years who underwent implantation of an epicardial PPM between 1997 and 2009 were enrolled in this study. The patients' medical records were reviewed retrospectively. The ethics committee of the Sejong General Hospital approved the study.

Nine of the patients were neonates or young infants (under 1 year of age) and 29 were male. The mean age of the patients when they first underwent PPM implantation was 5.7 ± 4.8 years (range, 1 month to 17.3 years). The

Course of Hospitalization and Mortality and Morbidity

The most common reasons for PPM implantation were postoperative complete atrioventricular block (CAVB, n = 33, 62.3%) and sinus node dysfunction with atrial arrhythmia (n = 11, 20.8%). Eight patients presented with congenital CAVB (15.1%) and 1 patient (1.9%) had lone sinus node dysfunction. The mean overall follow-up period in the study was 8.0 ± 4.5 years (range, 2.1 months to 17.0 years). Most of the patients who only received a pacemaker or had surgery for lead implantation were discharged

Comment

Generally, the epicardial PPM has a shorter life span than the endocardial PPM [7, 8]. However, in most patients with congenital cardiac disease or pediatric patients who require PPM implantation it is impossible to avoid implantation of an epicardial PPM because of difficulty in access to the heart through small vessels or because of complicated intracardiac structures in patients with congenital cardiac disease [4]. Problems may also potentially be caused by disproportional lead lengths

References (25)

  • H.D. Esperer et al.

    Permanent epicardial and transvenous single- and dual-chamber cardiac pacing in children

    Thorac Cardiovasc Surg

    (1993)
  • F.H. Figa et al.

    Risk factors for venous obstruction in children with transvenous pacing leads

    Pacing Clin Electrophysiol

    (1997)
  • Cited by (31)

    • Neonates and infants requiring life-long cardiac pacing: How reliable are epicardial leads through childhood?

      2019, International Journal of Cardiology
      Citation Excerpt :

      In some patients with CHD, an upgrade to a dual-chamber pacing system is performed at the same time as a planned cardiac re-operation even prior to any malfunction of the single-chamber system. Compared to other studies with similar patient characteristics, the postoperative complication rate was extremely low in our study with only one infection in 134 procedures [4,6,8,9]. No revisions for wound dehiscence, PM generator migration or any other complication related to the PM pocket preparation were necessary.

    • Minimally invasive percutaneous epicardial placement of a prototype miniature pacemaker with a leadlet under direct visualization: A feasibility study in an infant porcine model

      2019, Heart Rhythm
      Citation Excerpt :

      This is typically avoided in infants and small children because of small stature, growth trajectory, venous capacitance, and possible concomitant congenital heart disease.5 Placing relatively large leads in small veins can lead to stenosis or venous obstruction, thrombus formation, and the potential for pulmonary emboli.6 Some forms of congenital heart disease, such as intracardiac shunts, systemic venous anomalies, and single ventricle physiology, may also preclude a transvenous approach to pacemaker implantation.

    • Surgical Outcomes of Permanent Epicardial Pacing in Neonates and Young Infants Less Than 1 Year of Age

      2019, Heart Lung and Circulation
      Citation Excerpt :

      In such cases, the generators were externally obvious, and this may be a reason lead fracture or lead sheath erosion was more common in young infants who crawl on their abdomens. In fact, we encountered more lead damage cases in our group (n = 5 of 48, 10.4%) compared with older children than were encountered in a cohort slightly larger than this study that included only nine patients less than 1 year of age (3 out of 53, 5.7% [9]). In addition to this practical problem, the visibility of the generator caused parents to frequently state that they were nervous when handling their babies especially after the babies started to crawl on their abdomens.

    • Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

      2015, Heart Rhythm
      Citation Excerpt :

      Neither atrial nor ventricular lead survival was affected by younger age at lead implantation or number of surgeries, factors that may theoretically impede lead performance because of the presence of fibrous adhesions. These findings demonstrate that overall epicardial lead survival is significantly better than that reported in previous studies in the pediatric population.2,6,11,12,16–19 In mixed pediatric cohorts consisting of patients with and without CHD, the short-term (2–2.5 years) and midterm (5–6 years) incidence of epicardial lead malfunction has previously been reported to be 10%–34% and 26%–40%, respectively, with a paucity of long-term data.12,17,20,21

    View all citing articles on Scopus
    View full text