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Ann Thorac Surg 2004;77:1366-1370
© 2004 The Society of Thoracic Surgeons

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Original article: cardiovascular

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

^a Department of Congenital Cardiology and Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom

Accepted for publication August 28, 2003.

^* Address reprint requests to Dr Thomson, Department of Congenital Heart Disease, Leeds General Infirmary, Great George St, Leeds LS1 3EX, UK
e-mail: john.thomson{at}lineone.net

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.

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