• Thomson John D R JD Department of Congenital Cardiology and Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom. john.thomson@lineone., Michael E Blackburn, Carin Van Doorn, Ann Nicholls, and Kevin G Watterson.
• Department of Congenital Cardiology and Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom. john.thomson@lineone.net
• Ann. Thorac. Surg. 2004 Apr 1; 77 (4): 1366-70.

BackgroundWe report on pediatric epicardial pacing activity, patient and lead survival for more than two decades in a single center.MethodsThe data cover 96 pacing leads implanted in 59 patients. Median age at implantation was 1.9 years (1 day to 18.2 years). Forty-four percent had structural cardiac disease. Most frequent indications for pacing were postoperative (42%) and congenital complete heart block (42%).ResultsMedian activity was 3 pacing leads per year; 326 patient pacing years were observed (median 11.9 years; range, 1.1 to 22 years). Death due to pacemaker failure occurred in a single patient. Lead failure occurred in 33 of 96 leads (median of 28 months postimplantation) with lead fracture the commonest cause (47%). Risk factors for lead failure were decade of implant and nonsteroid eluting leads. Acute implant energy thresholds were significantly lower for steroid than nonsteroid eluting leads but did not predict subsequent lead failure.ConclusionsThe epicardial approach has offered an effective solution to pacing problems in the pediatric age range. Lead survival has improved with more than 75% of modern steroid eluting leads surviving to 5 years.

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