O'Leary Edward T, Baskar Shankar, Dionne Audrey, Gauvreau Kimberlee, Howard Taylor S, Jackson Lanier B, Whitehill Robert D, Mah Douglas Y
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
The Heart Institute, Cincinnati Children's Hospital, Cincinnati, Ohio.
Heart Rhythm. 2025 Jan;22(1):170-180. doi: 10.1016/j.hrthm.2024.07.014. Epub 2024 Jul 14.
Infants with complete heart block (CHB) require epicardial pacemaker (PM) insertion. Prior studies described epicardial pacing outcomes in infants and children, although they were limited by small or heterogeneous populations.
This study aimed to explore patient- and procedure-level associations with device complications in infants with CHB who received a permanent PM.
This was a multicenter, retrospective cohort study including infants receiving an epicardial PM between 2000 and 2021 for CHB. The primary outcome was time to device-related adverse event: lead failure requiring revision; pocket infection; exit block requiring increased pacing output; or lead-related coronary artery compression. Time-to-event analysis was performed by the Kaplan-Meier method with a multivariable Cox proportional hazards model.
There were 174 infants who 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 year. Age ≤90 days at PM implantation was the most significant risk factor for a device-related adverse event (hazard ratio, 7.02; P < .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 implantation is especially associated with infectious complications. Epicardial lead durability appears similar to previously reported pediatric experiences.
患有完全性心脏传导阻滞（CHB）的婴儿需要植入心外膜起搏器（PM）。先前的研究描述了婴儿和儿童的心外膜起搏结果，尽管这些研究受到样本量小或人群异质性的限制。
本研究旨在探讨接受永久性PM的CHB婴儿中与设备并发症相关的患者和手术层面的关联因素。
这是一项多中心回顾性队列研究，纳入了2000年至2021年间因CHB接受心外膜PM的婴儿。主要结局是发生与设备相关不良事件的时间：需要翻修的导线故障；囊袋感染；需要增加起搏输出的出口阻滞；或与导线相关的冠状动脉压迫。采用Kaplan-Meier方法和多变量Cox比例风险模型进行事件发生时间分析。
共有174例因CHB接受心外膜PM的婴儿（282根双极导线，39根单极导线）。植入PM时的中位年龄和体重分别为93.5天和4.5千克。起搏指征为术后CHB的占63%，先天性CHB的占37%。中位随访时间为2.1年。26例婴儿发生了主要结局，事件发生的中位时间为0.6年。植入PM时年龄≤90天是与设备相关不良事件的最显著危险因素（风险比，7.02；P <.001），主要由囊袋感染所致。3%的导线发生了故障，5年和10年无故障生存率分别为93%和83%。
设备并发症影响了15%接受永久性PM治疗心脏传导阻滞的婴儿。植入PM时年龄≤90天尤其与感染性并发症相关。心外膜导线的耐用性似乎与先前报道的儿科经验相似。
