Thuraiaiyah Jani, Jensen Annette Schophuus, De Backer Ole, Lim Chee Woon, Idorn Lars, Jakobsen Frederikke Noerregaard, Joergensen Troels Hoejsgaard, Schmidt Michael Rahbek, Smerup Morten, Johansen Jens Brock, Riahi Sam, Sondergaard Lars, Nielsen Jens Cosedis, Philbert Berit Thornvig, Jons Christian
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
Heart Rhythm. 2025 Aug;22(8):e416-e424. doi: 10.1016/j.hrthm.2025.03.1986. Epub 2025 Mar 27.
Cardiac implantable electronic devices (CIEDs) can be implanted epicardially or transvenously in children. Both techniques involve procedure-specific complications, and evidence for the choice of technique in children of different ages is scarce.
The purpose of this study was to characterize a complete national pediatric cohort with de novo CIED implantation and compare the risks and causes of reintervention between transvenous and epicardial CIED recipients.
This retrospective nationwide cohort study included all Danish children aged ≤15 years receiving a CIED from 1977 to 2021. Outcomes included time to first reintervention stratified by age and implantation technique. Reintervention was due to either battery depletion or lead or generator complication.
A total of 376 children received an epicardial (n = 131 [35%]) or transvenous (n = 245 [65%]) CIED with median [interquartile range] follow-up of 14 [6-21] years. Median age was 6 [1-11] years. For epicardial recipients, complication-driven reintervention was equal across age groups (P = .10), whereas among transvenous recipients the risk was significantly lower with increasing age (P <.001). Age-specific risk analyses revealed different risks for children aged <1 year, 1-8 years, and 9-15 years (P <.001). For children <1 year, a complication-driven reintervention was more frequent for transvenous vs epicardial recipients (P <.001), whereas in children aged 9-15 years, the opposite was observed (P = .02).
Transvenous implantation in children <1 year and epicardial implantation in children 9-15 years was associated with higher risk of CIED-related complication leading to reintervention, whereas for children aged 1-8 years, the complication risk was similar between implantation techniques.
心脏植入式电子设备（CIEDs）可通过心外膜或经静脉途径植入儿童体内。两种技术都存在特定于手术的并发症，而针对不同年龄段儿童选择技术的证据很少。
本研究的目的是描述一个完整的全国性儿科队列，这些儿童首次植入CIED，并比较经静脉和心外膜CIED接受者再次干预的风险和原因。
这项回顾性全国队列研究纳入了1977年至2021年期间所有接受CIED的15岁及以下丹麦儿童。结局包括按年龄和植入技术分层的首次再次干预时间。再次干预是由于电池耗尽或导线或发生器并发症。
共有376名儿童接受了心外膜（n = 131 [35%]）或经静脉（n = 245 [65%]）CIED，中位[四分位间距]随访时间为14 [6 - 21]年。中位年龄为6 [1 - 11]岁。对于心外膜接受者，并发症驱动的再次干预在各年龄组中相同（P = 0.10），而在经静脉接受者中，随着年龄增长风险显著降低（P < 0.001）。年龄特异性风险分析显示，1岁以下、1 - 8岁和9 - 15岁儿童的风险不同（P < 0.001）。对于1岁以下儿童，经静脉接受者并发症驱动的再次干预比心外膜接受者更频繁（P < 0.001），而在9 - 15岁儿童中则观察到相反情况（P = 0.02）。
1岁以下儿童经静脉植入和9 - 15岁儿童心外膜植入与CIED相关并发症导致再次干预的风险较高相关，而对于1 - 8岁儿童，两种植入技术的并发症风险相似。
