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Thirty years of experience with epicardial pacing in children

Published online by Cambridge University Press:  21 January 2005

Nicolas Noiseux ,
Paul Khairy ,
Anne Fournier  and
Suzanne J. Vobecky
Nicolas Noiseux
Affiliation:
Department of Cardiovascular Surgery, Hôpital Sainte-Justine, Montreal, Canada
Paul Khairy
Affiliation:
Department of Electrophysiology Service, Children’s Hospital Boston, Harvard Medical School, Hôpital Sainte-Justine, Montreal, Canada
Anne Fournier
Affiliation:
Department of Pediatric Cardiology, Hôpital Sainte-Justine, Montreal, Canada
Suzanne J. Vobecky
Affiliation:
Department of Cardiovascular Surgery, Hôpital Sainte-Justine, Montreal, Canada
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Abstract

Due to underlying cardiovascular anatomy and size, epicardial pacing may be the preferred method of pacing in small children. To assess long-term safety, we reviewed all epicardial pacemakers implanted in children between 1971 and 2001. We found that 122 patients, with a median age of 5.4 years, had a total of 181 pacemakers and 260 electrodes implanted over a total follow-up of 789 patient-years. Of the total, 12 patients died after the first implantation, with one death attributable to dysfunction of the pacemaker. Reintervention was required in 75 patients after 5.0 ± 3.2 years, due to depletion of the battery in 45 patients (60%), fracture or dysfunction of electrodes in 27 patients (36%), and infection in 3 patients (4%). In univariate analyses, risk factors for reintervention were an approach via a median sternotomy, with a relative risk of 2.3 (p = 0.0087), and an indication for pacing other than atrioventricular block, with a relative risk of 1.7 (p = 0.0314). In multivariate analyses, the approach via the median sternotomy independently predicted the need for reintervention, with a relative risk of 2.1, and 95% confidence intervals from 1.1 to 4.1 (p = 0.0256). The longevity of the second pacemaker and/or its electrode, assessed in 26 patients, was 3.7 ± 2.6 years, not shorter than the first implantation (p = 0.4037). We conclude that epicardial pacing is a reliable means of achieving permanent pacing in children, with low morbidity and mortality. A substantial proportion, nonetheless, requires reintervention within five years, warranting meticulous follow-up.

Keywords

Epicardial pacingchildrenlong-term safety
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 5 , October 2004 , pp. 512 - 519
Copyright
© 2004 Cambridge University Press

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