Permanent endocardial pacing in pediatric patients.

Improved technology with smaller pulse generators and passive and active fixation endocardial lead systems has the potential for facilitating safe, reliable pacing in pediatric patients. Of 18 pediatric patients (mean age 11.1 years) undergoing permanent transvenous cardiac pacing during the period April, 1977, to January, 1981, two (11%) required reoperation during a mean follow-up of 18.8 months. Satisfactory stable pacing was maintained even in patients with dual-chamber pacing systems and in patients with transposition of the great vessels in whom a lead was placed in a morphologically left atrium. This reoperation rate of 11% contrasts with a reoperation rate of 32% in 22 pediatric patients (mean age 8.7 years) who underwent placement of ventricular-demand epicardial pacing systems during the same period. In our experience, transvenous endocardial pacing is the preferred route in pediatric patients because of the improved lead system survival and the potential for atrial or atrioventricular sequential pacing.