Europace Advance Access published online on April 24, 2007
Europace, doi:10.1093/europace/eum043
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Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants
1 Department of Pediatric Cardiology, Ospedale Bambino Gesù, I.R.C.C.S., Piazza S. Onofrio 4, 00165 Roma, Italy; 2 Epidemiologic Unit, Ospedale Bambino Gesù, I.R.C.C.S., Piazza S. Onofrio 4, 00165 Roma, Italy; 3 Imaging Department, Ospedale Bambino Gesù, I.R.C.C.S., Piazza S. Onofrio 4, 00165 Roma, Italy
Aims Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred.
Methods and results We evaluated the results of children 
1 year who underwent pacemaker (PM) implantation at our centre with a retrospective analysis. Between 1992 and 2004, 56 patients, 37 of whom had other congenital heart defects (CHDs), received a PM at 4.4 ± 3.8 months of age for atrioventricular block (n = 52) and sinus node dysfunction. Rate-responsive ventricular demand pacing (VVIR) PMs were implanted in 25 patients (19 ENDO), dual-chamber demand pacing (DDD) in 29, and rate-responsive atrial demand pacing (AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 ± 3.5 (range 0.3–13) years: 15 pacing system failures occurred among the 56 patients (26%) after 4.5 ± 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18% of atrial, 24% of ventricular leads) than in ENDO (5% of ventricular leads). No venous occlusion was found at FU.
Conclusions Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.
Key Words: Cardiac pacing, Paediatric age, Pacing complications, Endocardial pacing, Epicardial pacing, Pacing leads
* Corresponding author. Tel: +39 06 68591; fax: +39 06 68592257; E-mail address: silvetti{at}opbg.net
Manuscript submitted 3 October 2006. Accepted after revision 27 February 2007.
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  M. S. Silvetti, F. Drago, S. Marcora, and L. Rava Outcome of single-chamber, ventricular pacemakers with transvenous leads implanted in children Europace, October 1, 2007; 9(10): 894 - 899. [Abstract] [Full Text] [PDF]
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