title: Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate long-term outcome of pacemakers (PMs) in paediatric patients.
  
  
  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 approximately 2% in all patients.
  
  
  CONCLUSIONS
  Pacing in children shows good results, but complications are frequent and related to leads. Endocardial pacing showed better long-term outcome.
authors.affiliation: Aritmologia, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, 00165 Roma, Italia. silvetti@opbg.net
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.forename: Giorgia
authors.initials: G
authors.lastname: Grutter
authors.forename: Antonella
authors.initials: A
authors.lastname: De Santis
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Di Ciommo
authors.forename: Lucilla
authors.initials: L
authors.lastname: Ravà
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006331:Heart Diseases / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome