Pacing activity, patient and lead survival over 20 years of permanent epicardial pacing in children

Background We report on pediatric epicardial pacing activity, patient and lead survival for more than two decades in a single center. Methods The data cover 96 pacing leads implanted in 59 patients. Median age at implantation was 1.9 years (1 day to 18.2 years). Forty-four percent had structural cardiac disease. Most frequent indications for pacing were postoperative (42%) and congenital complete heart block (42%). Results Median activity was 3 pacing leads per year; 326 patient pacing years were observed (median 11.9 years; range, 1.1 to 22 years). Death due to pacemaker failure occurred in a single patient. Lead failure occurred in 33 of 96 leads (median of 28 months postimplantation) with lead fracture the commonest cause (47%). Risk factors for lead failure were decade of implant and nonsteroid eluting leads. Acute implant energy thresholds were significantly lower for steroid than nonsteroid eluting leads but did not predict subsequent lead failure. Conclusions The epicardial approach has offered an effective solution to pacing problems in the pediatric age range. Lead survival has improved with more than 75% of modern steroid eluting leads surviving to 5 years.