Surgical Outcomes of Permanent Epicardial Pacing in Neonates and Young Infants Less Than 1 Year of Age

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Open surgical implantation of epicardial leads in neonates and infants remains the first option of treatment. We reviewed the long-term outcomes after epicardial pacemaker implantation in neonates and infants. Methods: From 1989 to 2016, 48 patients (16 neonates) underwent pacemaker implantation within the first year of life. Their median age and weight were 66.5 days (range: 0∼319 days), and 4.2 kg (range: 1.9∼9.3 kg), respectively, at the time of first pacemaker implantation. The indications for pacemaker implantation were postoperative or congenital atrioventricular block, sinus node dysfunction, and/or myocarditis-induced atrioventricular block. Forty-six (46) unipolar epicardial leads (non-steroid-eluting: 22; steroid-eluting: 24) and two bipolar leads (steroid-eluting) were inserted using a median sternotomy or subxiphoid approach. Results: The mean follow-up duration was 8.5 ± 7.9 years. The most commonly used generator mode at first implantation was VVI (n = 24, 50.0%). Eleven (11) generator mode changes from the initial VVI or VVIR to dual-chamber pacing were made at a mean of 7.0 ± 6.2 years after the first implantation for better inter-chamber synchrony and ventricular function. Freedom from reoperation for generator change after the first implantation was 95.3, 70.6, and 21.9% at 1, 5, and 10 years. Eighteen (18) lead malfunction events (34.1%) were detected. Freedom from reoperation for lead change was 97.8, 76.2, and 46.3% at 1, 5, and 10 years. The lead replacement rate was significantly higher in patients with non-steroid-eluting than steroid-eluting leads (p = 0.045). Conclusions: Neonates and infants require more frequent changes in pacemaker generator and leads than the older population. The use of steroid-eluting leads increased lead longevity and reduced the need for surgical re-interventions.

Original languageEnglish
Pages (from-to)1127-1133
Number of pages7
JournalHeart Lung and Circulation
Volume28
Issue number7
DOIs
StatePublished - 1 Jul 2019

Fingerprint

Steroids
Newborn Infant
Atrioventricular Block
Reoperation
Sick Sinus Syndrome
Sternotomy
Ventricular Function
Myocarditis
Weights and Measures
Population
Lead
Therapeutics

Keywords

  • Infant
  • Neonate
  • Pacemaker
  • Pacing complications

Cite this

@article{9b2499728c7a4a57991a73e55f44db56,
title = "Surgical Outcomes of Permanent Epicardial Pacing in Neonates and Young Infants Less Than 1 Year of Age",
abstract = "Background: Open surgical implantation of epicardial leads in neonates and infants remains the first option of treatment. We reviewed the long-term outcomes after epicardial pacemaker implantation in neonates and infants. Methods: From 1989 to 2016, 48 patients (16 neonates) underwent pacemaker implantation within the first year of life. Their median age and weight were 66.5 days (range: 0∼319 days), and 4.2 kg (range: 1.9∼9.3 kg), respectively, at the time of first pacemaker implantation. The indications for pacemaker implantation were postoperative or congenital atrioventricular block, sinus node dysfunction, and/or myocarditis-induced atrioventricular block. Forty-six (46) unipolar epicardial leads (non-steroid-eluting: 22; steroid-eluting: 24) and two bipolar leads (steroid-eluting) were inserted using a median sternotomy or subxiphoid approach. Results: The mean follow-up duration was 8.5 ± 7.9 years. The most commonly used generator mode at first implantation was VVI (n = 24, 50.0{\%}). Eleven (11) generator mode changes from the initial VVI or VVIR to dual-chamber pacing were made at a mean of 7.0 ± 6.2 years after the first implantation for better inter-chamber synchrony and ventricular function. Freedom from reoperation for generator change after the first implantation was 95.3, 70.6, and 21.9{\%} at 1, 5, and 10 years. Eighteen (18) lead malfunction events (34.1{\%}) were detected. Freedom from reoperation for lead change was 97.8, 76.2, and 46.3{\%} at 1, 5, and 10 years. The lead replacement rate was significantly higher in patients with non-steroid-eluting than steroid-eluting leads (p = 0.045). Conclusions: Neonates and infants require more frequent changes in pacemaker generator and leads than the older population. The use of steroid-eluting leads increased lead longevity and reduced the need for surgical re-interventions.",
keywords = "Infant, Neonate, Pacemaker, Pacing complications",
author = "Kwak, {Jae Gun} and Sungkyu Cho and Woonghan Kim",
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language = "English",
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Surgical Outcomes of Permanent Epicardial Pacing in Neonates and Young Infants Less Than 1 Year of Age. / Kwak, Jae Gun; Cho, Sungkyu; Kim, Woonghan.

In: Heart Lung and Circulation, Vol. 28, No. 7, 01.07.2019, p. 1127-1133.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Surgical Outcomes of Permanent Epicardial Pacing in Neonates and Young Infants Less Than 1 Year of Age

AU - Kwak, Jae Gun

AU - Cho, Sungkyu

AU - Kim, Woonghan

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Background: Open surgical implantation of epicardial leads in neonates and infants remains the first option of treatment. We reviewed the long-term outcomes after epicardial pacemaker implantation in neonates and infants. Methods: From 1989 to 2016, 48 patients (16 neonates) underwent pacemaker implantation within the first year of life. Their median age and weight were 66.5 days (range: 0∼319 days), and 4.2 kg (range: 1.9∼9.3 kg), respectively, at the time of first pacemaker implantation. The indications for pacemaker implantation were postoperative or congenital atrioventricular block, sinus node dysfunction, and/or myocarditis-induced atrioventricular block. Forty-six (46) unipolar epicardial leads (non-steroid-eluting: 22; steroid-eluting: 24) and two bipolar leads (steroid-eluting) were inserted using a median sternotomy or subxiphoid approach. Results: The mean follow-up duration was 8.5 ± 7.9 years. The most commonly used generator mode at first implantation was VVI (n = 24, 50.0%). Eleven (11) generator mode changes from the initial VVI or VVIR to dual-chamber pacing were made at a mean of 7.0 ± 6.2 years after the first implantation for better inter-chamber synchrony and ventricular function. Freedom from reoperation for generator change after the first implantation was 95.3, 70.6, and 21.9% at 1, 5, and 10 years. Eighteen (18) lead malfunction events (34.1%) were detected. Freedom from reoperation for lead change was 97.8, 76.2, and 46.3% at 1, 5, and 10 years. The lead replacement rate was significantly higher in patients with non-steroid-eluting than steroid-eluting leads (p = 0.045). Conclusions: Neonates and infants require more frequent changes in pacemaker generator and leads than the older population. The use of steroid-eluting leads increased lead longevity and reduced the need for surgical re-interventions.

AB - Background: Open surgical implantation of epicardial leads in neonates and infants remains the first option of treatment. We reviewed the long-term outcomes after epicardial pacemaker implantation in neonates and infants. Methods: From 1989 to 2016, 48 patients (16 neonates) underwent pacemaker implantation within the first year of life. Their median age and weight were 66.5 days (range: 0∼319 days), and 4.2 kg (range: 1.9∼9.3 kg), respectively, at the time of first pacemaker implantation. The indications for pacemaker implantation were postoperative or congenital atrioventricular block, sinus node dysfunction, and/or myocarditis-induced atrioventricular block. Forty-six (46) unipolar epicardial leads (non-steroid-eluting: 22; steroid-eluting: 24) and two bipolar leads (steroid-eluting) were inserted using a median sternotomy or subxiphoid approach. Results: The mean follow-up duration was 8.5 ± 7.9 years. The most commonly used generator mode at first implantation was VVI (n = 24, 50.0%). Eleven (11) generator mode changes from the initial VVI or VVIR to dual-chamber pacing were made at a mean of 7.0 ± 6.2 years after the first implantation for better inter-chamber synchrony and ventricular function. Freedom from reoperation for generator change after the first implantation was 95.3, 70.6, and 21.9% at 1, 5, and 10 years. Eighteen (18) lead malfunction events (34.1%) were detected. Freedom from reoperation for lead change was 97.8, 76.2, and 46.3% at 1, 5, and 10 years. The lead replacement rate was significantly higher in patients with non-steroid-eluting than steroid-eluting leads (p = 0.045). Conclusions: Neonates and infants require more frequent changes in pacemaker generator and leads than the older population. The use of steroid-eluting leads increased lead longevity and reduced the need for surgical re-interventions.

KW - Infant

KW - Neonate

KW - Pacemaker

KW - Pacing complications

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U2 - 10.1016/j.hlc.2018.06.1039

DO - 10.1016/j.hlc.2018.06.1039

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SN - 1443-9506

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