Complications of permanent pacing in children depending on the method of implantation

Background. Currently pacing is the only treatment option for life-threatening bradyarrhythmias. Considering the specific factors of pediatric patients, specialists in this field should be highly professional. Aim. To present the experience and retrospective analysis of complications of permanent pacing in children and adolescents from Tomsk National Research Medical Center. Material and Methods. Complications of permanent pacing in children with structurally normal heart and children with congenital heart defects were analyzed. The follow-up was from 1999 to 2021 years. 256 patients aged from 1 month to 18 years participated in the study. Epicardial pacemaker was implanted in 173 children, endocardial – in 83 patients. Average time from primary implantation to complications was 2.1 ± 2.7 years. Results. Hemodynamic complications are the most common among patients with epicardial and endocardial permanent pacing. Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dissynchrony due to stimulation in the area of the lateral wall or the right ventricular outflow tract. In patients with endocardial permanent pacing hemodynamic complications are associated with the development of pacemaker-induced cardiomyopathy due to permanent pacing of the right ventricle apex and tricuspid regurgitation. Complications such as bacterial endocarditis, infection of the pacemaker and its bed, hemopericardium, subclavian vein occlusion, pericarditis, peacemaker dislocation and lead fracture were less common. Two cases of cardiac strangulation were detected. Conclusion. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. Implantation of the electrode on the apex of the left ventricle (epicardial pacemaker system), in the area of the His bundle (endocardial pacemaker system), prevents the development of hemodynamic complications. The most rational is the use of a primary epicardial pacemaker system. Such approach allows the veins to be preserved for endocardial stimulation at an older age.