Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants

Research output: Contribution to journalArticle

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Abstract

Aims: Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred. Methods and results: We evaluated the results of children ≤1 year who underwent pacemaker (PM) implantation at our centre with a retrospective analysis. Between 1992 and 2004, 56 patients, 37 of whom had other congenital heart defects (CHDs), received a PM at 4.4 ± 3.8 months of age for atrioventricular block (n = 52) and sinus node dysfunction. Rate-responsive ventricular demand pacing (VVIR) PMs were implanted in 25 patients (19 ENDO), dual-chamber demand pacing (DDD) in 29, and rate-responsive atrial demand pacing (AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 ± 3.5 (range 0.3-13) years: 15 pacing system failures occurred among the 56 patients (26%) after 4.5 ± 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18% of atrial, 24% of ventricular leads) than in ENDO (5% of ventricular leads). No venous occlusion was found at FU. Conclusions: Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.

Original languageEnglish
Pages (from-to)426-431
Number of pages6
JournalEuropace
Volume9
Issue number6
DOIs
Publication statusPublished - Jun 2007

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Newborn Infant
Congenital Heart Defects
Sick Sinus Syndrome
Atrioventricular Block
Safety

Keywords

  • Cardiac pacing
  • Endocardial pacing
  • Epicardial pacing
  • Pacing complications
  • Pacing leads
  • Paediatric age

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants. / Silvetti, Massimo Stefano; Drago, Fabrizio; De Santis, Antonella; Grutter, Giorgia; Ravà, Lucilla; Monti, Lidia; Fruhwirth, Rodolfo.

In: Europace, Vol. 9, No. 6, 06.2007, p. 426-431.

Research output: Contribution to journalArticle

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abstract = "Aims: Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred. Methods and results: We evaluated the results of children ≤1 year who underwent pacemaker (PM) implantation at our centre with a retrospective analysis. Between 1992 and 2004, 56 patients, 37 of whom had other congenital heart defects (CHDs), received a PM at 4.4 ± 3.8 months of age for atrioventricular block (n = 52) and sinus node dysfunction. Rate-responsive ventricular demand pacing (VVIR) PMs were implanted in 25 patients (19 ENDO), dual-chamber demand pacing (DDD) in 29, and rate-responsive atrial demand pacing (AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 ± 3.5 (range 0.3-13) years: 15 pacing system failures occurred among the 56 patients (26{\%}) after 4.5 ± 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18{\%} of atrial, 24{\%} of ventricular leads) than in ENDO (5{\%} of ventricular leads). No venous occlusion was found at FU. Conclusions: Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.",
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