Midterm Follow-up and Outcome of Pacemakers in Children: A Single Center Experience

Pacemaker implantation is an effective life-long treatment in patients with atrioventricular block to generate a reliable heartbeat. Choosing between epicardial and endocardial (trans-venous) techniques in children is based on the cardiac center experience and each technique has some benefits and risks.

In this observational cross-sectional study, we reviewed file-records of 186 under 18- year-old patients who underwent cardiac pacemaker implantation due to atrioventricular block. All of endocardial implantations had been performed by experienced pediatric cardiologists and all epicardial pacemakers by experienced cardiac surgeon from 2006 to 2018 in Namazi and Faghihi hospitals in Shiraz, Iran.

One hundred and five patients had epicardial pacemaker and 81 patients had endocardial pacemaker. One hundred and seventy-eight patients had postoperative complete heart block after correction of congenital cardiac abnormality due to the destruction of conductive pathway. Eight patients were born with complete heart block. Four (2.15%) patients in the endocardial group developed pacemaker related infection. Two (1%) patients had sudden cardiac death after pacemaker insertion in the follow-up; Medtronic single chamber pacemaker was inserted for one patient who had complete heart block after surgical ventricular septal defect closure. However, a month later she expired due to sudden cardiac arrest during exercise and one patient after correction of complete atrio-ventricular septal defect had pacemaker insertion and sudden death, 3 months after pace insertion (1.12%); none of them had history of palpitation, syncope, arrhythmia in their post-operation electrocardiography, or tachycardia in their pacemaker analysis.

In Conclusion, epicardial pacemaker has a noticeable battery longevity in comparison to endocardial pacemakers and fewer valvular complications and endocarditis cases. Also, it appears that increasing size and vessel stiffness followed by aging can prime better vascular access and less lead malfunction in older pediatrics in endocardial approach; however, the site of ventricular pacing is still a puzzle because of the effect of pacing site on left ventricle synchrony and ejection fraction.