Journal Article

Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients

Massimo Stefano Silvetti, Fabrizio Drago, Giorgia Grutter, Antonella De Santis, Vincenzo Di Ciommo and Lucilla Ravà

in EP Europace

Published on behalf of European Heart Rhythm Association of the European Society of Cardiology (ESC)

Volume 8, issue 7, pages 530-536
Published in print July 2006 | ISSN: 1099-5129
Published online July 2006 | e-ISSN: 1532-2092 | DOI: http://dx.doi.org/10.1093/europace/eul062
Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients

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Aims The aim of this study was to evaluate long-term outcome of pacemakers (PMs) in paediatric patients.

Methods and results Patients' data were retrospectively reviewed. We recorded the techniques and systems used, any complication, and outcome. Endocardial leads were inserted by transcutaneous puncture of subclavian vein and fixed with a non-absorbable ligature, and epicardial leads by standard surgical technique. Lead survival was calculated and plotted with the product limit method of Kaplan–Meier. Between 1982 and 2002, 292 patients, aged 8±7 years (range 1 day–18 years), underwent PM implantation: the first PM had endocardial leads in 165 patients and epicardial in 127 patients. Structural heart disease (HD) was present in 239 patients. Follow-up was 5±4 (range 0.1–18) years. There were no pacing-related deaths. In total, 211 endocardial implantation procedures with 90 atrial and 165 ventricular leads and 145 epicardial procedures with 103 atrial and 123 ventricular leads were performed. Early (<3 months) complications: haemothorax occurred in 3.5% of endocardial leads and dislodgement was not significantly different for atrial and ventricular endocardial leads. Late complications: 63 leads failed (48 epicardial), with the worst outcome for conventional epicardial leads (31 vs. 9% endocardial, P<0.05; steroid eluting 8% epicardial vs. 5% endocardial, P=NS). Endocardial atrial leads failed (7%) in operated HD and ventricular leads failed (6%) after body growth, without difference in estimated mean survival time (11 years). Early and late PM infection/erosion was ∼2% in all patients.

Conclusion Pacing in children shows good results, but complications are frequent and related to leads. Endocardial pacing showed better long-term outcome.

Keywords: Cardiac pacing; Paediatric age; Endocardial pacing; Epicardial pacing; Pacing complications; Congenital heart disease

Journal Article.  4447 words.  Illustrated.

Subjects: Cardiovascular Medicine

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