TY - EJOU
AU - Khorgami, Mohammadrafie
AU - Tabaei, Ali Sadeghpour
AU - Caruso, Elio
AU - Farruggio, Silvia
AU - Omidi, Negar
AU - Moradian, Maryam
AU - Ahranjani, Behzad Mohammadpour
AU - Zamani, Zahra Khajali6 and Rahele
TI - Epicardial Versus Endocardial Pacemakers in the Pediatric Population: A Comparative Inquiry
T2 - Congenital Heart Disease
PY - 2021
VL - 16
IS - 6
SN - 1747-0803
AB - 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.
KW - Pacemaker; congenital heart defects; cardiac pacing; pediatrics
DO - 10.32604/CHD.2021.016271