Key result
Pediatric permanent pacing linked to ~83% 10-year freedom from lead complications, with PICM limited to CHD.
Why the study?
Permanent cardiac pacing in children requires long-term management, but long-term device-associated complications and pacing-induced cardiomyopathy data are limited.
What are the long-term rates of device-associated complications and pacing-induced cardiomyopathy in pediatric patients requiring permanent pacemakers?
Observational (n=53)
No
What are the long-term rates of device-associated complications and pacing-induced cardiomyopathy in pediatric patients requiring permanent pacemakers?
In children requiring permanent pacing, long-term epicardial lead survival is acceptable, but pacing-induced cardiomyopathy is a significant risk particularly in patients with underlying congenital heart disease.
Background: Permanent cardiac pacing in children is commonly indicated in high-grade atrioventricular block. These patients require long-term ventricular pacing (Vp), multiple device changes, and lead revisions. Objectives: To describe a single pediatric center's 30-year experience with permanent pacemaker implantation, focusing on long-term device-associated complications (DACs) and pacing-induced cardiomyopathy (PIC). Methods: We conducted a retrospective observational study at KK Women's and Children's Hospital, Singapore. Patients with permanent pacemakers followed between January 1, 1994 and December 31, 2024 were included. Primary outcomes were DAC and PIC. Results: Fifty-three patients underwent 113 pacemaker lead implantations; 51 (96.2%) had epicardial systems. Median follow-up was 12 years (interquartile range [IQR] 9-19 years). Median age at first pacemaker implantation was 16 months (IQR 2 months to 7.7 years). Congenital complete heart block was the most common indication (26 [49%]), followed by postoperative complete heart block (17 [32%]). Freedom from lead-associated complications was 85% and 83% at 5 and 10 years, respectively. Eight (15%) patients developed PIC. All patients with PIC had concomitant congenital heart disease (CHD) (8/8). CHD was present in 28.9% (13/45) of patients without PIC. Recovery of ventricular function occurred in two patients following pacing modification, but not in those managed with medical therapy alone. Conclusion: In this pediatric cohort with predominantly epicardial pacing systems, long-term DAC rates were acceptable. PIC occurred primarily in patients with CHD. These findings support careful pacing strategy selection and long-term surveillance in children requiring permanent pacing.
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Chan et al. (2026) conducted an observational in High-grade or complete atrioventricular block requiring permanent pacing (n=53). Permanent cardiac pacing was evaluated on Device-associated complications (DAC) and pacing-induced cardiomyopathy (PIC). Permanent cardiac pacing in children was associated with an 83% freedom from lead-associated complications at 10 years, while pacing-induced cardiomyopathy occurred in 15% of patients, exclusively in those with congenital heart disease.
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