Permanent cardiac pacing in children: morbidity and efficacy of follow-up.

The data from 50 permanently paced children [mean standard deviation follow-up 5.3 +/- 3.7 years] were reviewed, with special attention being paid to the cause of complications and the efficacy of follow-up. The 5-year survival (SD) of the patients was 78 +/- 6%; mortality was mainly due to the underlying cardiac disease. The 5-year survival (SD) of the pacing systems was 48 +/- 8%. Surgical interventions were necessary every 4.9 patient years. Of these interventions, 58% were caused by lead-related problems. Epicardial leads showed significantly more exit blocks and high thresholds than endocardial leads. Endocardial leads, therefore, should be used at a younger age than is now the current practice, from 5 years of age onwards, for example. If epicardial leads are used, the pacemaker must have a high output facility. Since exit block occurred only within the first 3 months after implantation, we suggest frequent transtelephonic monitoring during the first 3 months. Holter monitoring appeared to be the most effective and sensitive method of detecting malsensing and should be performed regularly.