Long-term of outcome of cardiac pacing in neonates

Abstract

The advent of technology has made it safe to implant pacemakers (PM) in children. However, safety of neonatal PM implantation is unclear. We aim to report our experience with neonatal PM implantation in regard to visibility and long-term outcome. We performed a retrospective analysis of patients (PTS) who underwent PM implantation during the first month of life at our institution. The data obtained: demographics, diagnoses, indications for pacing, follow-up, and PM revisions. Between April-1988 and May-2011, Twenty-nine neonates (15 males) underwent PM implantation, median age 14 days (range 2–30) weight 3.1 Kg (range 2–4.5). The indications for pacing were: surgical AV block (12), congenital AV block in (16), and Long QT syndrome (1). All PM’s were epicardial single chamber system with abdominal pocket and VVI mode. The median pacing threshold at implant was 0.8 V at 0.5 ms (range 0.5–1.7). There were no PM infections, wound dehiscence or PM related mortality; however there were three deaths after palliation for complex congenital heart disease. The PTS were followed for 7 years (1–24) during which 15 revisions were done for 13 patients. The initial revision was needed after median of 5 years (4–9) for battery depletion (10), upgrade (2), and lead malfunction (1). One PTS developed cardiomyopathy after 3.5 years of pacing and improved with cardiac resynchronization. Pacemakers are a safe in neonates including low birth weight. Pacemaker related morbidity and mortality are rare however longer follow up is need to assess the effect of pacing on ventricular function.