Medium-term follow-up and modes of failure following epicardial pacemaker implantation in young children.
OBJECTIVE
Young children suffering from congenital or post-operative AV-block require life-long pacemaker stimulation. Due to the anatomical prerequisites initially epicardial electrodes are implanted and the generator is placed in the upper abdominal wall. The following study investigated modes of failure leading to reoperation in this group of technically challenging patients.


RESULTS
Between October 2000 and May 2005, a total of 21 infants (age 3 days to 5 years) underwent pacemaker implantation using a subxyphoidal incision for newborns (and a partial lower or complete median sternotomy for older children). Nine patients had previous cardiac surgery for complex congenital defects. The remaining 12 young children suffered from congenital AV-Block (CAVB). Twenty-one bipolar epicardial electrodes (Medtronic Capsure epi) were fixed to the right ventricle, 15 had additional implantation of a bipolar atrial lead. The pacemaker generator (Medtronic Kappa 701) was implanted into the right upper abdominal wall. Indications for revision were recorded. No mortality was observed; pacing and sensing parameters remained stable up to a 5-year follow-up. A total of four reoperations occurred. Three of the four revisions were caused by ventricular electrode fracture. At revision, two electrodes were broken at the crossing between the pericardial cavity and the abdominal wall, one bipolar lead at the Y-division into the two tip electrodes. One reoperation was due to a pacemaker recall. All revisions were performed without complications.


CONCLUSIONS
In our institute epicardial pacing in young children was associated with a satisfactory clinical outcome, but also a significant number of failures leading to reoperation, mainly due to electrode fracture caused by the muscular activity of this patient group. Reoperations were performed at a low risk.
Bakhtiary
Farhad
F
Department of Thoracic and Cardiovascular Surgery of Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60596 Frankfurt/Main, Germany. farhad@bakhtiary.de
Dzemali
Omer
O
Bastanier
Christian K
CK
Moritz
Anton
A
Kleine
Peter
P
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000151:congenital* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D012086:Reoperation; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome