Follow up observation of permanent epicardial pacing

<p><strong>Objective:</strong> To summarize the safety and long-term efficacy of epicardial permanent pacemaker implantation. Methods 69 patients who underwent epicardial permanent pacemaker implantation in Wuhan Asian heart hospital from December 2009 to November 2019 and were followed up at least once after discharge were selected. In 23 children, single chamber pacemakers were implanted through right ventricular epicardium; Among 46 adults, 19 were implanted with pacing electrodes through left ventricular epicardium and 27 through right ventricular epicardium. Follow up the changes of electrode parameters and adverse events within 1 week, 1~3 months, 1~3 years and more than 5 years after operation.</p><p><strong>Results</strong>: Right ventricular electrodes were fixed in 50 cases, of which 37 cases were fixed on the right ventricular diaphragmatic surface and 13 cases were fixed on the right ventricular outflow tract; the left ventricular electrodes were fixed in 19 cases, of which 15 were fixed in the lateral wall of the left ventricle, 2 in the posterior wall of the left ventricle, and 2 in the diaphragmatic surface of the left ventricle. The median follow-up was 48.6 months. All 69 patients were discharged smoothly without operation related complications. Two patients with giant left ventricular cardiomyopathy died of heart failure after cardiac resynchronization therapy (CRT), and one patient with CRT implantation underwent heart transplantation 12 months after operation because of poor efficacy. The pulse generator was replaced in 12 cases because the pacemaker battery was exhausted. Electrode breakage occurred in 4 cases, and bag infection occurred in 1 case. The ventricular thresholds (median) within 1 week, 1~3 months, 1~3 years and more than 5 years after epicardial electrode implantation were 1.0v/0.4ms, 0.75v/0.4ms, 0.8v/0.4ms and 1.0v/0.4ms respectively. The left ventricular epicardial electrode threshold was the same as that of the right ventricle, and that of children and adults. Conclusion the parameters of epicardial electrode are stable for a long time, but the safety is not good.</p>