Device-related complications in a national pediatric cardiac implantable electronic device cohort stratified after age and implantation technique

Background: Cardiac implantable electronic devices (CIEDs) can be implanted epicardially or transvenously in children. Both techniques involve procedure-specific complications, and evidence for the choice of technique in children of different ages is scarce. Objectives: The purpose of this study was to characterize a complete national pediatric cohort with de novo CIED implantation and compare the risks and causes of reintervention between transvenous and epicardial CIED recipients. Methods: This retrospective nationwide cohort study included all Danish children aged ≤15 years receiving a CIED from 1977 to 2021. Outcomes included time to first reintervention stratified by age and implantation technique. Reintervention was due to either battery depletion or lead or generator complication. Results: A total of 376 children received an epicardial (n = 131 [35%]) or transvenous (n = 245 [65%]) CIED with median [interquartile range] follow-up of 14 [6–21] years. Median age was 6 [1–11] years. For epicardial recipients, complication-driven reintervention was equal across age groups (P = .10), whereas among transvenous recipients the risk was significantly lower with increasing age (P <.001). Age-specific risk analyses revealed different risks for children aged <1 year, 1–8 years, and 9–15 years (P_interaction <.001). For children <1 year, a complication-driven reintervention was more frequent for transvenous vs epicardial recipients (P <.001), whereas in children aged 9–15 years, the opposite was observed (P = .02). Conclusion: Transvenous implantation in children <1 year and epicardial implantation in children 9–15 years was associated with higher risk of CIED-related complication leading to reintervention, whereas for children aged 1–8 years, the complication risk was similar between implantation techniques.