Document Type : Original Article

Authors

1 Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Pediatric, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran

3 Cardiovascular Research Center, Shiraz University of Medical Sciences,Shiraz, Iran

Abstract

Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.

Keywords

1. Sachweh J. Twenty years' experience with pediatric pacing: epicardial and transvenous stimulation. European Journal of Cardio-Thoracic Surgery. 2000;17(4):455-461.
2. Janoušek J, van Geldorp I, Krupičková S, Rosenthal E, Nugent K, Tomaske M Et al. Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site. Circulation. 2013;127(5):613-623.
3. Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicenter survey. Indian Heart Journal. 2012;64(2):220-221.
4. Tomaske M, Breithardt O, Bauersfeld U. Preserved cardiac synchrony and function with single-site left ventricular epicardial pacing during mid-term follow-up in paediatric patients. Europace. 2009;11(9):1168-1176.
5. Ward D, Jones S, Shinebourne E. Long-term transvenous pacing in children weighing ten kilograms or less. International Journal of Cardiology. 1987;15(1):112-115.
6. ROBLEDO-NOLASCO R, ORTIZ-AVALOS M, RODRIGUEZ-DIEZ G, JIMENEZ-CARRILLO C, RAMÍREZ-MACHUCA J, DE HARO S et al. Transvenous Pacing in Children Weighing Less than 10 Kilograms. Pacing and Clinical Electrophysiology. 2009;32:S177-S181.
7. Jacques F, Côté J, Philippon F. Long-term outcome of transvenous pacemaker implantation in infants: a retrospective cohort study. EP Europace. 2017;20(7):1227-1227.
8. BAR-COHEN Y, BERUL C, ALEXANDER M, FORTESCUE E, WALSH E, TRIEDMAN J Et al. Age, Size, and Lead Factors Alone Do Not Predict Venous Obstruction in Children and Young Adults with Transvenous Lead Systems. Journal of Cardiovascular Electrophysiology. 2006;17(7):754-759.
9. Kwak J, Kim S, Song J, Choi E, Lee S, Shim W Et al. Permanent Epicardial Pacing in Pediatric Patients: 12-Year Experience at a Single Center. The Annals of Thoracic Surgery. 2012;93(2):634-639.
10. Cohen M, Bush D, Vetter V, Tanel R, Wieand T, Gaynor J Et al. Permanent Epicardial Pacing in Pediatric Patients. Circulation. 2001;103(21):2585-2590.
11. M. Beaufort-Krol G, Mulder H, Nagelkerke D, Waterbolk T, Bink-Boelkens M. Comparison of longevity, pacing, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children. The Journal of Thoracic and Cardiovascular Surgery. 1999;117(3):523-528.