title: Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial?
abstract: OBJECTIVE
  Cardiac pacing is a difficult technique in children, particularly in patients with congenital heart defects (CHDs). Few studies to date have addressed this topic.
  
  
  RESULTS
  We performed a retrospective analysis of the results of a single centre. Between 1982 and 2008, 287 patients with CHD, median age of 5 years (25-75%, 1-11) underwent cardiac pacing for sinus node dysfunction (SND) and atrioventricular block (AVB); 97% of patients underwent at least one heart surgery. Endocardial systems (Endo) were implanted in 117 patients, epicardial systems (Epi) in 170, with 595 leads (228 Endo, 367 Epi). Endocardial systems showed a significantly older age group with more frequent SND; Epi a younger age group, with more frequent AVB, greater number of surgical interventions. Perioperative complications were mortality 0.6% (Epi), pericardial effusion 0.6% (Epi), and haemothorax 3.4% (Endo). The median follow-up is 5 (2-10) years: the pacing system failed in 29% of patients, 13% Endo, and 40% Epi (P < 0.0001). Multivariate analysis showed a significantly higher risk of failure for Epi, a lower implant age, greater the number of leads implanted. The risk of malfunction of the leads increases significantly for Epi and the younger age when implanted. The steroid-eluting leads have a lower risk of malfunction (P = 0.05), steroid-eluting Endo leads provide significantly better outcomes than Epi.
  
  
  CONCLUSIONS
  Cardiac pacing in paediatric patients with CHD shows satisfactory results in the long term. Endocardial systems show significantly better results than Epi systems. A younger age when implanted is a risk factor for complications at follow-up.
authors: Unità Operativa di Aritmologia/Syncope Unit, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica Bambino Gesu` Children’s Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy. silvetti@opbg.net
authors: Massimo Stefano
authors: MS
authors: Silvetti
authors: Fabrizio
authors: F
authors: Drago
authors: Duccio
authors: D
authors: Di Carlo
authors: Silvia
authors: S
authors: Placidi
authors: Gianluca
authors: G
authors: Brancaccio
authors: Adriano
authors: A
authors: Carotti
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D054537:Atrioventricular Block / Q000401:mortality* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods / Q000401:mortality*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004699:Endocardium / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000534:rehabilitation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D010496:Pericardium / Q000601:surgery; D015995:Prevalence; D019919:Prosthesis Implantation / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012804:Sick Sinus Syndrome / Q000401:mortality* / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cardiac pacing; Children; Congenital heart defects; Endocardial pacing; Epicardial pacing; Pacing complication