title: Thirty years of experience with epicardial pacing in children.
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.
authors.affiliation: Department of Cardiovascular Surgery, Children's Hospital Boston, Harvard Medical School, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Anne
authors.initials: A
authors.lastname: Fournier
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Vobecky
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D012189:Retrospective Studies