Equivalent Performance of Epicardial Versus Endocardial Permanent Pacing in Children: A Single Institution and Manufacturer Experience

Citations of this article
Mendeley users who have this article in their library.


Background: Children requiring permanent pacing have a lifelong need for follow-up. Epicardial leads have traditionally fared worse than endocardial counterparts. We tested the hypothesis that steroid-eluting epicardial and endocardial leads had equivalent outcomes. Methods: We reviewed medical records of 148 children, mean age 8.2 ± 4.8 years, in whom a dual-chamber pacemaker system with steroid-eluting leads from a single manufacturer was implanted. Primary outcome was mortality. Secondary outcomes included freedom from lead failure and pacemaker system reintervention. Loss of capture-sensing, lead displacement-fracture, exit block, and high thresholds constituted lead failure. Reintervention included need for lead revision or generator change. Results: There was no early mortality. Late mortality occurred once (0.5 ± 0.5 deaths/1,000 patient-months) and eight times (3.4 ± 1.2 deaths/1,000 patient-months) in the endocardial and epicardial groups, respectively. The relative hazard of endocardial versus epicardial site for lead failure was 0.408 (p = 0.038) and for reintervention was 0.629 (p = 0.002). Endocardial and epicardial groups differed in important ways: concomitant cardiac surgery 5% (3 of 61) versus 27% (27 of 99); congenital heart disease 33% (20 of 61) versus 90% (89 of 99); single ventricle physiology 13% (8 of 61) versus 52% (51/99); and age (10.5 ± 4.5 years vs 5.5 ± 5.2 years). Adjusting for these covariants, the relative hazard for freedom from lead failure for endocardial versus epicardial leads was 0.546 (p = 0.360). The adjusted relative hazard for freedom from reintervention was 0.157 (p = 0.045). Conclusions: Technologic advances attenuate important differences in lead failure rates between endocardial and epicardial steroid-eluting pacing leads and thus bridge the performance gap between these fixation modes. © 2008 The Society of Thoracic Surgeons.




Odim, J., Suckow, B., Saedi, B., Laks, H., & Shannon, K. (2008). Equivalent Performance of Epicardial Versus Endocardial Permanent Pacing in Children: A Single Institution and Manufacturer Experience. Annals of Thoracic Surgery, 85(4), 1412–1416. https://doi.org/10.1016/j.athoracsur.2007.12.075

Register to see more suggestions

Mendeley helps you to discover research relevant for your work.

Already have an account?

Save time finding and organizing research with Mendeley

Sign up for free