Original articlePediatric cardiacPermanent Epicardial Pacing in Pediatric Patients: 12-Year Experience at a Single Center
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
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Cited by (31)
Temporary epicardial pacing after cardiac surgery
2023, BJA EducationNeonates and infants requiring life-long cardiac pacing: How reliable are epicardial leads through childhood?
2019, International Journal of CardiologyCitation 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 RhythmCitation 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 CirculationCitation 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 RhythmCitation 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