Transvenous cardiac pacing in children: Problems and complications during follow-up

Objective: Transvenous permanent cardiac pacing (TPCP) has become a frequently used therapeutic modality in children. The purpose of this study was to evaluate the outcome of pediatric TPCP regarding problems and complications. Methods: Records of 155 patients (mean age 9.2±4.7 years) who underwent implantation of TPCP between 1993 and 2003 were reviewed retrospectively. Indications for pacing included atrioventricular block in 76% and sinus node dysfunction in 22% patients. In 92 patients, bradyarrhythmia was secondary to cardiac surgery. Percutaneous subclavian puncture was used for lead implantation in 96% of patients. Pacemakers were placed to the right side of the chest in 84% and in the subpectoral area in 68%. Pacing modes were VVIR in 72%, VDD in 13%, AAIR in 8%, and DDD in 7% of patients at the initial implantation time. Of all electrodes, 95% had steroid elution and 53% had an active fixation mechanism. Mean follow-up period was 37±28 (1-120) months. Results: Forty-five (29%) patients had 21 minor and 45 major complications. Forty-four of 76 revisions were due to lead problems and battery extraction. Most of the lead problems were dislodgment and stretching (n=14). Kaplan Meier analysis of lead survival did not show any difference between lead types. During the follow-up, there were three sudden unexpected deaths. Conclusions: In children, TPCP can be used safely and effectively. Although, complications are possible and sometimes lead or generator revision may be necessary, long-term outcome is favorable.