TRENDS IN PEDIATRIC CARDIAC PACING

OBJECTIVE: To review retrospectively a 31-year experience with pediatr ic cardiac pacing at the University of Toronto, with an emphasis on th e changing trends in pacemaker implantation in infants and children. D ATA SOURCE: Data were obtained from the pediatric pacemaker follow-up clinic at The Hospital for Sick Children, Toronto, Ontario or from the referring pediatric centre. Follow-up was normally continued until th e death of the child or referral to an adult hospital at age 18 years. PATIENT SELECTION: The study comprised 397 children (under 18 years o f age) who underwent initial pacemaker implantation at The Hospital fo r Sick Children between January 1962 and December 31, 1992. Follow-up was 99% complete (five children lost) and ranged from one month to 32 years (mean 6.5 years). DATA SYNTHESIS: The use of endocardial versus epicardial leads increased significantly over time (P<0.001). In addit ion, significantly more children receiving pacemakers had sick sinus s yndrome (P<0.001). No difference in survival was found between childre n paced by endocardial versus epicardial leads or between children pac ed for sick sinus syndrome versus atrioventricular block. The frequenc y of exit block, by lifetable analysis, did not differ between childre n who received epicardial versus endocardial leads. CONCLUSIONS: Guide lines for permanent pacemaker implantation in children continus to evo lve as developments in lead technology alter trends in pediatric cardi ac pacing.