Permanent Cardiac Pacing in Children: A 30-Year Follow-Up Retrospective Study in a Single Pediatric Asian Center.

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.