Yet concerns about dual chamber pacing remain. Last year we discussed atrial electrode longevity and its impact upon patient management. Yet generator longevity is of equal concern and may not be inferred from either the adult experience or the manufacturer's estimates due to the increased heart rates in children and the extensive use of epicardial electrodes with lower impedance and therefore higher current drain. Finally programming issues unique to DDD pacing such as management of retrograde conduction, pacemaker mediated tachycardia and management of atrial flutter must be considered but will not be further addressed today.