Infants with complete heart block (CHB) require epicardial pacemaker (PM) insertion. Prior studies described epicardial pacing outcomes in infants and children though were limited by small and/or heterogeneous populations. To explore patient and procedural-level associations with device complications in infants with CHB who received a permanent PM. Multicenter, retrospective cohort study including infants receiving an epicardial PM between 2000-2021 for CHB. The primary outcome was time to device-related adverse event (DRAE): (1) lead failure requiring revision; (2) pocket infection; (3) exit block requiring increased pacing output; or (4) lead-related coronary artery compression. Time to event analysis was performed using the Kaplan-Meier method with a multivariable Cox proportional hazards model. 174 infants received an epicardial PM (282 bipolar, 39 unipolar leads) for CHB. Median age and weight at PM were 93.5 days and 4.5 kg, respectively. Pacing indication was postoperative CHB in 63% and congenital CHB in 37%. The median follow-up was 2.1 years. The primary outcome occurred in 26 infants at a median time to event of 0.6 years. Age ≤90 days at PM was the most significant risk factor for DRAE (HR 7.02, p<0.001), primarily driven by pocket infections. Lead failure occurred in 3% of leads with a 5- and 10-year freedom from failure of 93% and 83%, respectively. Device complications affect 15% of infants receiving a permanent PM for heart block. Age ≤90 days at PM implant is especially associated with infectious complications. Epicardial lead durability appears similar to previously reported pediatric experiences.