Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants.
OBJECTIVE
Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred.


RESULTS
We evaluated the results of children <or=1 year who underwent pacemaker (PM) implantation at our centre with a retrospective analysis. Between 1992 and 2004, 56 patients, 37 of whom had other congenital heart defects (CHDs), received a PM at 4.4 +/- 3.8 months of age for atrioventricular block (n = 52) and sinus node dysfunction. Rate-responsive ventricular demand pacing (VVIR) PMs were implanted in 25 patients (19 ENDO), dual-chamber demand pacing (DDD) in 29, and rate-responsive atrial demand pacing (AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 +/- 3.5 (range 0.3-13) years: 15 pacing system failures occurred among the 56 patients (26%) after 4.5 +/- 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18% of atrial, 24% of ventricular leads) than in ENDO (5% of ventricular leads). No venous occlusion was found at FU.


CONCLUSIONS
Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.
Silvetti
Massimo Stefano
MS
Department of Pediatric Cardiology, Ospedale Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Roma, Italy. silvetti@opbg.net
Drago
Fabrizio
F
De Santis
Antonella
A
Grutter
Giorgia
G
Ravà
Lucilla
L
Monti
Lidia
L
Fruhwirth
Rodolfo
R
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D004699:Endocardium; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome