Evaluation of Different Lead Types and Implantation Techniques in Pediatric Populations with Permanent Pacemakers: Single-Center with Ten Years’ Experience

Background: Permanent pacemaker implantation is performed for various indications and by different techniques in children; however, many problems with lead performance are encountered during follow-up. This study aims to evaluate the possible effects of different lead types and implantation techniques on pacing at early and midterm in children with a permanent pacemaker.

Patients and methods: Pediatric patients who underwent permanent pacemaker system implantation at our tertiary cardiac surgery center between 1 January 2010 and 1 January 2020 were evaluated retrospectively. Patients were categorized in the epicardial pacing lead (EP), transvenous pacing lead (TP), and transvenous bipolar lumenless (Select Secure™) (SS) lead groups according to the lead implantation technique and lead type with the same manufacturer. Groups were evaluated statistically for demographic features, pacing type and indication for implantation, lead electrical performance, lead failure, complications, and outcome.

Results: Over 10 years, 323 lead implantations were performed on 167 patients (96 males, median age 68 months [5 days-18 years]). Out of 323 leads, 213 (66%) were EP, 64 (20%) were TP, and 46 (14%) were SS. Out of the total, 136 of the leads were implanted in atria, and 187 were implanted in ventricles. Primary pacing indications were postoperative complete AV block (n = 95), congenital AV block (n = 71), sinus node dysfunction (n = 13), and acquired complete AV block (n = 1). Additional cardiac diseases were present in 115 patients (69%). No statistically significant difference was observed in gender, syndrome, or pacing indication (p > 0.05). Atrial and ventricular capture, threshold, sensing, and lead impedance measurements were not significantly different at the initial and follow-up periods (p > 0.05). The median follow-up duration was 3.3 years (6 months-10 years). Twenty lead failures were determined in 15 patients (EP: 14 lead failures in 10 patients; TP: 2 lead failures in 2 patients; and SS: 4 lead failures in 3 patients) during follow-up, and no statistically significant difference was found between groups (p = 0.466). The five-year lead survival was 98% for TP, 95% for EP, and 90% for SS; the 10-year lead survival was 90% for TP, 70% for EP, and 70% for SS. There was no mortality related to chronic pacing or due to the procedure of implantation.

Conclusions: Despite improvements in technology, lead failure is still one of the most critical problems during these patients’ follow-up. Early to mid-term lead survival rates of all three lead types were satisfactory.