Long-term follow-up after pacemaker implantation in neonates and infants.
BACKGROUND
Pacemaker (PM) system implantation in neonates and infants is often complicated by hemodynamic instability, small vessel size, and abnormal cardiovascular anatomy. Thus, an open surgical approach for epicardial lead insertion is often required. We assessed the long-term outcomes after epicardial PM implantation in this age group.


METHODS
Between 1992 and 2004, 22 consecutive patients underwent PM implantation within the first year of life. Bipolar steroid-eluting epicardial leads (Medtronic CapSure Epi 10366 and 4968) were inserted through median sternotomy, the sybxyphoid approach, or thoracotomy, and connected to various pulse generators.


RESULTS
Pacemakers were implanted at a median age of 35 days (range, 1 to 300). Intracardiac anatomy was abnormal in 17 patients. Indications for PM therapy were heart block in 18 patients and sinus node dysfunction in 4 patients. During a median follow-up of 4.6 years (range, 4 days to 12.8 years), 7 devices were replaced owing to end of battery life (n = 6) or elective device repositioning (n = 1), at a median of 4.1 years (range, 1 to 7.8). One dislodged ventricular lead and 2 atrial lead sensing failures were observed. Sensing, pacing thresholds, and lead impedances showed good implant and stable follow-up values.


CONCLUSIONS
Pacemaker-associated morbidity is low. Pacemaker system complications with epicardial leads are rare. Battery life is relatively shorter compared with children and adults because of the fast heart rate and complete PM dependency in most of these children. Even for neonates and infants, modern pacemaker therapy is feasible, safe, and effective.
Aellig
Natalie C
NC
Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland.
Balmer
Christian
C
Dodge-Khatami
Ali
A
Rahn
Mariette
M
Prêtre
René
R
Bauersfeld
Urs
U
D000367:Age Factors; D001919:Bradycardia / Q000151:congenital / Q000401:mortality / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000401:mortality*; D015331:Cohort Studies; D016001:Confidence Intervals; 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; D011336:Probability; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome