Open Access

ARTICLE

Epicardial Versus Endocardial Pacemakers in the Pediatric Population: A Comparative Inquiry

by Mohammadrafie Khorgami¹, Ali Sadeghpour Tabaei^2,*, Elio Caruso^3,*, Silvia Farruggio³, Negar Omidi⁴, Maryam Moradian¹, Behzad Mohammadpour Ahranjani⁵, Zahra Khajali⁶, Rahele Zamani¹

1 Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Cardiovascular Surgery Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
3 Department of Pediatric Cardiology, Mediterranean Pediatric Cardiology Center “Bambin Gesù”, San Vincenzo Hospital, Taormina, 98039, Italy
4 Cardiac Primary Prevention Research Center, Tehran Heart Center and Department of Cardiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5 Pediatric Cardiology, Bahrami Children’s Hospital, Tehran University of Medical Science, Tehran, Iran
6 Adult Congenital Heart Disease Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

* Corresponding Authors: Ali Sadeghpour Tabaei. Email: ; Elio Caruso. Email:

Congenital Heart Disease 2021, 16(6), 573-584. https://doi.org/10.32604/CHD.2021.016271

Received 22 February 2021; Accepted 17 April 2021; Issue published 08 July 2021

Abstract

Background: Most children in need of cardiac pacemakers remain dependent on the function of the permanent from childhood to adulthood. We sought to evaluate and compare the function between epicardial and endocardial pacemakers in pediatric groups with different conditions. Methods: Between 2012 and 2018, this single-canter study evaluated 44 pediatric patients with indications for epicardial or endocardial pacemakers. Results: The 2 groups, at a median age of 5 (0.1–16) years, were compared concerning the characteristics of the leads used (n = 80: bipolar, unipolar, steroid-eluting, and non–steroid-eluting), survival data, and complications. The reason for pacemaker implantation was congenital complete heart block in 11 (25%) cases and postoperative heart block in 33 (75%) cases. The commonest congenital heart disease accompanied by postoperative block was the ventricular septal defect. In the endocardial lead group, the mean ventricular pacing threshold immediately after the implantation and during the follow-up was less than that in the epicardial lead group (0.75 vs. 0.81 V; P = 0.01 and 0.8 vs. 2.4 V; P = 0.001). During the follow-up, the mean battery longevity was better in the endocardial group (last visit: 6.7 endocardial vs. 3.3 years epicardial). Lead failure was commoner in the epicardial pacemaker, and chronic high-pacing threshold pattern was seen in 14 patients in this group. After 3 years, freedom from lead failure was 94% and 63% in the endocardial and epicardial leads. Conclusions: Pacemakers with endocardial bipolar steroid-eluting leads showed better lead characteristics regarding survival and battery longevity than epicardial pacemakers without these lead characteristics. An appropriate pacemaker type should be selected based on the patient’s condition.

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