title: Transvenous cardiac pacing in children: problems and complications during follow-up.
abstract: OBJECTIVE
  Transvenous permanent cardiac pacing (TPCP) has become a frequently used therapeutic modality in children. The purpose of this study was to evaluate the outcome of pediatric TPCP regarding problems and complications.
  
  
  METHODS
  Records of 155 patients (mean age 9.2+/-4.7 years) who underwent implantation of TPCP between 1993 and 2003 were reviewed retrospectively. Indications for pacing included atrioventricular block in 76% and sinus node dysfunction in 22% patients. In 92 patients, bradyarrhythmia was secondary to cardiac surgery. Percutaneous subclavian puncture was used for lead implantation in 96% of patients. Pacemakers were placed to the right side of the chest in 84% and in the subpectoral area in 68%. Pacing modes were VVIR in 72%, VDD in 13%, AAIR in 8%, and DDD in 7% of patients at the initial implantation time. Of all electrodes, 95% had steroid elution and 53% had an active fixation mechanism. Mean follow-up period was 37+/-28 (1-120) months.
  
  
  RESULTS
  Forty-five (29%) patients had 21 minor and 45 major complications. Forty-four of 76 revisions were due to lead problems and battery extraction. Most of the lead problems were dislodgment and stretching (n=14). Kaplan Meier analysis of lead survival did not show any difference between lead types. During the follow-up, there were three sudden unexpected deaths.
  
  
  CONCLUSIONS
  In children, TPCP can be used safely and effectively. Although, complications are possible and sometimes lead or generator revision may be necessary, long-term outcome is favorable.
authors.affiliation: Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Alpay
authors.initials: A
authors.lastname: Celiker
authors.forename: Osman
authors.initials: O
authors.lastname: Başpinar
authors.forename: Tevfik
authors.initials: T
authors.lastname: Karagöz
mesh_terms: D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D017063:Outcome Assessment, Health Care; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology