Abstract 17032: Long Term Pacing Outcomes in Pediatric Patients Without Structural Heart Disease
Background: Pediatric cardiac pacing is in the fifth decade, yet long term outcomes in this population are not well defined. This study describes pediatric patients with structurally normal hearts who required cardiac pacing for greater than ten years, with emphasis on frequency of additional procedures and markers of cardiac function.
Methods: A retrospective review of patients with structurally normal hearts who required single or dual chamber cardiac pacing for ≥ ten years. All patients were implanted at Boston Children’s Hospital from 1973 to 2000.
Results: 72 patients were implanted at mean age of 9.6 years (range 0 - 30 years). Complete AV block was the indication in forty six (64%) patients. Mean interval follow - up was 19.1 years (range 10.2 - 35.1 years). The most common complications were lead related: fracture 23 (32%), insulation break 8 (11%) and stretch 7 (10%). 1372 total patient-years were accrued. Excluding initial implant, 204 additional procedures were performed (incidence 1.49/decade, CI 1.28, 1.69). 63 were complication related interventions (0.46/decade, CI 0.35, 0.57). 18 patients (25%) required ≥5 additional procedures. Serial echocardiographic data was available in 32 patients with ≥95% RV pacing. In this subset, shortening fraction (FS) decreased by a mean of 3±9%. LV end diastolic dimension z-score increased by 0.05±1.67. No patient had FS decrease of ≥ 15% or required intervention for decreased cardiac function. On univariate analysis, younger age at first implant (p= 0.03) was the only variable associated with complication related intervention.
Conclusions: Over two decades, paced patients with normal cardiac anatomy required three additional procedures on average. Although there was a small decrease in measured LV function associated with long term pacing, this was not clinically significant. In this group, factors promoting system longevity may be of similar clinical relevance as avoidance of pacing mediated dysfunction.
- © 2013 by American Heart Association, Inc.