Hostname: page-component-7d684dbfc8-w65q4 Total loading time: 0 Render date: 2023-09-23T06:49:46.953Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

Thirty years of experience with epicardial pacing in children

Published online by Cambridge University Press:  21 January 2005

Nicolas Noiseux
Department of Cardiovascular Surgery, Hôpital Sainte-Justine, Montreal, Canada
Paul Khairy
Department of Electrophysiology Service, Children’s Hospital Boston, Harvard Medical School, Hôpital Sainte-Justine, Montreal, Canada
Anne Fournier
Department of Pediatric Cardiology, Hôpital Sainte-Justine, Montreal, Canada
Suzanne J. Vobecky
Department of Cardiovascular Surgery, Hôpital Sainte-Justine, Montreal, Canada


Due to underlying cardiovascular anatomy and size, epicardial pacing may be the preferred method of pacing in small children. To assess long-term safety, we reviewed all epicardial pacemakers implanted in children between 1971 and 2001. We found that 122 patients, with a median age of 5.4 years, had a total of 181 pacemakers and 260 electrodes implanted over a total follow-up of 789 patient-years. Of the total, 12 patients died after the first implantation, with one death attributable to dysfunction of the pacemaker. Reintervention was required in 75 patients after 5.0 ± 3.2 years, due to depletion of the battery in 45 patients (60%), fracture or dysfunction of electrodes in 27 patients (36%), and infection in 3 patients (4%). In univariate analyses, risk factors for reintervention were an approach via a median sternotomy, with a relative risk of 2.3 (p = 0.0087), and an indication for pacing other than atrioventricular block, with a relative risk of 1.7 (p = 0.0314). In multivariate analyses, the approach via the median sternotomy independently predicted the need for reintervention, with a relative risk of 2.1, and 95% confidence intervals from 1.1 to 4.1 (p = 0.0256). The longevity of the second pacemaker and/or its electrode, assessed in 26 patients, was 3.7 ± 2.6 years, not shorter than the first implantation (p = 0.4037). We conclude that epicardial pacing is a reliable means of achieving permanent pacing in children, with low morbidity and mortality. A substantial proportion, nonetheless, requires reintervention within five years, warranting meticulous follow-up.

Original Article
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Sliz Jr NB, Johns JA. Cardiac pacing in infants and children. Cardiol Rev 2000; 8: 223239.Google Scholar
Hamilton R, Gow R, Bahoric B, Griffiths J, Freedom R, Williams W. Steroid-eluting epicardial leads in pediatrics: improved epicardial thresholds in the first year. Pacing Clin Electrophysiol 1991; 14: 20662072.Google Scholar
Karpawich PP, Hakimi M, Arciniegas E, Cavitt DL. Improved chronic epicardial pacing in children: steroid contribution to porous platinized electrodes. Pacing Clin Electrophysiol 1992; 15: 11511157.Google Scholar
Johns JA, Fish FA, Burger JD, Hammon Jr JW. Steroid-eluting epicardial pacing leads in pediatric patients: encouraging early results. J Am Coll Cardiol 1992; 20: 395401.Google Scholar
Cutler NG, Karpawich PP, Cavitt D, Hakimi M, Walters HL. Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol 1997; 20: 29432948.Google Scholar
Maginot KR, Mathewson JW, Bichell DP, Perry JC. Applications of pacing strategies in neonates and infants. Prog Pediatr Cardiol 2000; 11: 6575.Google Scholar
Rao V, Williams WG, Hamilton RH, Williams MG, Goldman BS, Gow RM. Trends in pediatric cardiac pacing. Can J Cardiol 1995; 11: 993999.Google Scholar
Kugler JD, Danford DA. Pacemakers in children: an update. Am Heart J 1989; 117: 665679.Google Scholar
Beaufort-Krol GC, Mulder H, Nagelkerke D, Waterbolk TW, Bink-Boelkens MT. Comparison of longevity, pacing, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children. J Thorac Cardiovasc Surg 1999; 117: 523528.Google Scholar
Cohen MI, Bush DM, Vetter VL, et al. Permanent epicardial pacing in pediatric patients: seventeen years of experience and 1200 outpatient visits. Circulation 2001; 103: 25852590.Google Scholar
Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol 1998; 31: 11751209.Google Scholar
Jimenez M, Fournier A, Hery E, et al. Cardiac pacemakers in children. 15 years’ experience. Arch Mal Coeur Vaiss 1988; 81: 665670.Google Scholar
Villain E, Martelli H, Bonnet D, Iserin L, Butera G, Kachaner J. Characteristics and results of epicardial pacing in neonates and infants. Pacing Clin Electrophysiol 2000; 23: 20522056.Google Scholar
Mond HG, Stokes KB. The steroid-eluting electrode: a 10-year experience. Pacing Clin Electrophysiol 1996; 19: 10161020.Google Scholar
Esperer HD, Singer H, Riede FT, Blum U, Mahmoud FO, Weniger J. Permanent epicardial and transvenous single- and dual-chamber cardiac pacing in children. Thorac Cardiovasc Surg 1993; 41: 2127.Google Scholar
Hoorntje T, Kammeraad J, Bennink G, Sreeram N. Transvenous permanent pacemaker implantation in neonates. Int J Cardiol 2000; 75: 103104.Google Scholar
DeLeon SY, Ilbawi MN, Backer CL, et al. Exit block in pediatric cardiac pacing. Comparison of the suture-type and fishhook epicardial electrodes. J Thorac Cardiovasc Surg 1990; 99: 905910.Google Scholar
Serwer GA, Mericle JM, Armstrong BE. Epicardial ventricular pacemaker electrode longevity in children. Am J Cardiol 1988; 61: 104106.Google Scholar
Sachweh JS, Vazquez-Jimenez JF, Schondube FA, et al. Twenty years experience with pediatric pacing: epicardial and transvenous stimulation. Eur J Cardiothorac Surg 2000; 17: 455461.Google Scholar
Hamilton RM, Chiu C, Gow RM, Williams WG. A comparison of two stab-on unipolar epicardial pacing leads in children. Pacing Clin Electrophysiol 1997; 20: 631636.Google Scholar
Cohen MI, Vetter VL, Wernovsky G, et al. Epicardial pacemaker implantation and follow-up in patients with a single ventricle after the Fontan operation. J Thorac Cardiovasc Surg 2001; 121: 804811.Google Scholar
Bonatti V, Agnetti A, Squarcia U. Early and late postoperative complete heart block in pediatric patients submitted to open-heart surgery for congenital heart disease. Pediatr Med Chir 1998; 20: 181186.Google Scholar
McCallister Jr BD, Vlietstra RE, Westbrook BM, Hayes DL. A transmural approach for endocardial ventricular pacing. Am J Cardiol 1990; 65: 263264.Google Scholar
Johnsrude CL, Backer CL, Deal BJ, Strasburger JF, Mavroudis C. Transmural atrial pacing in patients with postoperative congenital heart disease. J Cardiovasc Electrophysiol 1999; 10: 351357.Google Scholar
Ramesh V, Gaynor JW, Shah MJ, et al. Comparison of left and right atrial epicardial pacing in patients with congenital heart disease. Ann Thorac Surg 1999; 68: 23142319.Google Scholar
Hayes DL, Vlietstra RE. Pacemaker malfunction. Ann Intern Med 1993; 119: 828835.Google Scholar
Figa FH, McCrindle BW, Bigras JL, Hamilton RM, Gow RM. Risk factors for venous obstruction in children with transvenous pacing leads. Pacing Clin Electrophysiol 1997; 20: 19021909.Google Scholar
Gillette PC, Zeigler V, Bradham GB, Kinsella P. Pediatric transvenous pacing: a concern for venous thrombosis? Pacing Clin Electrophysiol 1988; 11: 19351939.Google Scholar