Permanent cardiac pacing in infants and children is associated with high rates of re-operation due to battery depletion, lead problems, and wound dehiscence, though overall prognosis depends primarily on underlying heart disease.
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Frequent re-operations in pediatric pacing warrant device refinements; leaves open need for prospective trials before practice change.
This clinical review details our 15 year experience with permanent cardiac pacemakers in 81 infants and children. Pacing was found inappropriate in one infant. The other 80 patients were paced because of congenital heart block [24], post-operative block [50], or sick sinus syndrome [6]. Maintenance of long-term pacing requires all too frequent re-operation for battery depletion [37%], lead related problems [32%] or wound dehiscence [31%]. Problems related to pacemaker size and the presence of a high myocardial threshold are particularly important in the pediatric patient. In spite of these problems, children requiring cardiac pacemakers can be extremely well, their prognosis depending almost entirely on the presence of underlying heart disease.
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Williams et al. (1978) studied this question.
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