Pacemaker Implantation in Pediatric Patients: What`s the Best Implantation Approach? A Single Center Experience.

AIMS. In pediatric patients pacemaker (PM) implantation can be correlated to complications over time, due to the small size of the vessels, to the growth and to the presence of complex congenital heart defects. Which is the best implantation technique is still under debate. METHODS. A population of 83 patients (with a total of 132 leads) who underwent pacemaker implantation at our Hospital has been studied retrospectively. RESULTS. The median follow up was of 7 years. Patients have a median age of 3 (0-8) years, at first implantation. The first PM implantation was performed with epicardial approach in 53 (63,8%) children and in 30 (36,2%) children with endocardial approach. AV Block was a consequence of cardiac surgery in 71,1% of patients and congenital in 28,9%. In the 83 patients, 132 leads were implanted, 93 (70,4%)epicardial and 39 endocardial (29,6%). Among epicardial leads, 52 (55,9%) were unipolar and 41 (44,1%) steroid eluting bipolar leads; among endocardial, 8 (20,5%) were unipolar and 31 (79,5%) bipolar. Median longevity of epicardial leads was 5 (2-8) years, instead the endocardial one was 7 (3-9) years. Considering only the patients implanted within 4 years old, epicardial approach showed lower complications rate than endocardial approach (30,3% vs 66,7%, p<0,05). Moreover, among epicardial leads, bipolar steroid eluting showed a significantly lower rate of complications than unipolar leads (11% vs 43,5%, p<0,05) and equal performance with respect to the endocardial bipolar leads. CONCLUSIONS. Between 0 and 4 years old, the implantation of epicardial bipolar steroid eluting leads is to prefer, as it shows a lower complication rate during follow up. There is no significant difference in older patients. Epicardial bipolar steroid eluting leads result comparable with endocardial leads in terms of complications and performance in the long term.