Characteristics and results of epicardial pacing in neonates and infants

The results of epicardial pacing in infants with isolated congenital comple te atrioventricular block (CAVB) are reported. Thirty-four patients, aged I day to 20 months (22 patients < 1 month), were paced between 1988 and 1998 . Thirty had bradycardia < 50 beats/min with symptoms in 12 patients, and 4 patients were paced because of associated ventricular ectopy or prolonged QT interval. In thirty cases, the electrodes were implanted through a left thoracotomy and connected to an abdominal generator; in four, the subxyphoi d approach was preferred. Twenty-two children had dual chamber units. There was no operative death, but three patients died later of cardiomyopathy. S even infants were reoperated for electrode displacement, infection, exit bl ock, and pacemaker sensitivity. Chronic ventricular thresholds ranged from 0.3 to 2 V except in one case (4 V) and proper atrial sensing was lost in t wo cases. All children are doing well and the generator has lasted at least 5 years in 16 cases. In conclusion, epicardial pacing in infants with CAVE can be done with satisfactory results. There was no mortality in relation with pacing and thresholds have improved with the use of steroid-eluting el ectrodes. The deep location of the generator prevents cutaneous erosion and allows implantation of large units with a longer life duration.