title: Permanent epicardial pacing in pediatric patients: 12-year experience at a single center.
abstract: BACKGROUND
  Permanent cardiac pacing is not often done in children, and when done is usually accomplished through epicardial pacing. We reviewed a 12-year experience with the implantation of epicardial pacemakers by our clinical group.
  
  
  METHODS
  Fifty-three patients who underwent their first implantation of an epicardial pacemaker before the age of 18 years and between 1997 and 2009 were included in our study. The mean age of the patients at the time of first pacemaker implantation was 5.7±4.8 years. Indications for pacemaker implantation included postoperative or congenital atrioventricular block and sinus node dysfunction. The patients underwent 105 operations for the replacement of pacemaker pulse generators and 75 operations for the replacement of pacemaker leads. The most commonly used generator mode was the rate-responsive accelerometer-based (DDDR) mode, which was used in 40.9% of the patients. We used more non-steroid-eluting leads (70.1%) than steroid-eluting leads (29.1%).
  
  
  RESULTS
  The overall duration of follow-up in the study was 8.0±4.5 years (range, 2.1 months to approximately 17.0 years). Freedom from the need for generator replacement was 98.0%, 60.7%, and 11.1% at 1, 5, and 8 years, respectively. A tendency toward early generator exhaustion was observed among younger patients (p=0.058). The generator mode used for pacing did not significantly affect generator longevity. Freedom from the need for lead replacement was 98.3%, 83.8%, and 63.6% at 1, 5, and 10 years, respectively. The mean longevity of the leads used in the study was 10.8±0.8 years. Neither patient age at the time of lead implantation nor type of lead significantly affected lead longevity.
  
  
  CONCLUSIONS
  Lead longevity was sufficiently long and did not vary significantly according to type of lead. Generator longevity was not affected by lead type, generator mode, or patient age at the time of pacemaker implantation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea.
authors.forename: Jae Gun
authors.initials: JG
authors.lastname: Kwak
authors.forename: Soo-Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Song
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Lee
authors.forename: Woo Sup
authors.initials: WS
authors.lastname: Shim
authors.forename: Chang-Ha
authors.initials: CH
authors.lastname: Lee
authors.forename: Cheul
authors.initials: C
authors.lastname: Lee
authors.forename: Chun Soo
authors.initials: CS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D054537:Atrioventricular Block / Q000151:congenital / Q000601:surgery; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000601:surgery; D013997:Time Factors