Pacemaker Implantation in the First Year of Life: A Midterm Analysis

Objectives: For patients requiring a pacemaker (PM) implantation in the first year of life, epicardial PM systems are the only option. Studies focusing on this age group are scarce. The aim of the study was to evaluate mid-term results of permanent pacing in patients who received an epicardial PM within the first year of life.

Methods: We reviewed all patients who received an epicardial PM between 2000 and 2017. Inclusion criterion was age at time of surgery ≤ 1 year. The PM system was analyzed at the time of discharge, 2, 4, and more than 5 years after implantation. End-point of the study was durability of PM system, defined as reoperation for generator or lead exchange.

Results: A total of 71 patients with epicardial PM implantation were included, 29 PM systems were in VVI(R) mode and 42 in DDD(R) mode. Mean age at time of surgery was 4 ± 3 months and mean weight was 4 ± 2 kg. The indication for PM implantation was congenital heart block in 22 patients (31%), an acquired heart block in 44 (62%), a sick sinus syndrome in 4 (6%), and an atrioventricular block grade II type I in 1 (1%), respectively. Mean follow-up time was 6 ± 5 years (1 month to 17 years). Minimal energy threshold (MET) for atrial leads decreased significantly from 1.0 ± 0.9 µJ at discharge to 0.4 ± 0.3 µJ at more than 5 years (p < 0.001). MET for ventricular leads remained constant at 5 years follow-up (p = 0.970). Impedance of atrial leads increased during the study period from 571 ± 131 Ω to 612 ± 133 Ω (p < 0.001), whereas impedance for ventricular leads decreased from 603 ± 204 Ω to 490 ± 152 Ω (p < 0.001). In a total of 63 reoperations, 55 PM generators, 6 atrial, and 11 ventricular leads were exchanged. Mean time to PM generator exchange was 4 ± 2 years. Mean time to atrial lead exchange was 6 ± 4 years and to ventricular lead exchange 5 ± 4 years. Battery depletion (n = 38, 60%) and lead fracture (n = 6, 35%) were the most common reasons for reoperation. Freedom from PM generator exchange was 92, 85, and 60% at 1, 2, and 5 years, respectively. Freedom from atrial and ventricular lead exchange was comparable (96, 91, and 76% vs. 94, 82, and 75% at 2, 5, and 10 years, respectively, p = 0.45).

Conclusions: Epicardial pacing in neonates and infants shows excellent mid-term results. A low rate of lead-related complications and stable pacing thresholds after 5 years demonstrates the safety of this method. Although reoperations for generator exchange are common, epicardial leads may last for more than 10 years.