Between 1975-2007, 101 patients, aged 8 ± 5,6 years, 92 AV block and 9 sick sinus syndrome, underwent pacemaker (PM) implantation with 58 endocardial and 43 epicardial leads mode of pacing VVI-77, VVRR-5, VAT-2, VDD-13, DDD-4. The dysrithmia was postoperative in 36 pts, congenital in 58 and acquired in 7. Patients were followed up 8.9 ± 7.6 (0,1-27q4) years. Dilated cardiomyopathy (CMP) developed after PM implantation in 3 cases and caused death in all of them. During the follow up 137 reimplantations were performed with 132 generators and 55 leads were replaccad. After implantation 19 patients died (mortality 18,8 %). No relationship was found between mortality and tye type of dysrhythmia, mode of pacing or lead. Fourty seven complications needed reimplantations were observed in 38 pts – exit block(EB)-22; lead fracture (FL)-9, lead dislodgement-3; pocket infection -8 , decubitus-6, generator migration-2. The 1-, 5- and 10-year freedom from generator reipmlantation is 84%, 50%, 8%. Multivariate risk factor for generator reimplamtation (Cox regression analysis) is the age below 7 years (RR- 3,13). The 1-, 5-, 10- and 12 year freedom from lead reimplantation is 88%, 72%, 46%, 32%. Multivariate risk factors for lead replacement are age below 7 years, epicardial lead and complications (RR - 6,7).
Conclusion: the main factor for the choice of the lead and type of stimulation is the patient’s age. The age below 7 years, epicardial lead and complications are risk factors for reimlantation.