AIMS: To compare pacemaker reprogramming and re-intervention rates in children with AutoCapture (AC) and conventionally (Conv) programmed devices, and to assess reliability of device automaticity. METHODS AND RESULTS: Data of children with AC (group AC, n = 49) and conventionally programmed devices (group Conv, n = 41) were analysed. A total of 1106 outpatient visits and 147 Holter recordings were screened for device reprogramming and invasive re-intervention. At 2 and 5 years, freedom from reprogramming differed significantly between groups (AC: 63/35% vs. Conv: 13/4%; P < 0.0001), whereas freedom from re-intervention was not different (AC: 95/90% vs. Conv: 95/85%; P = 0.26). Mean yearly rate of reprogramming was lower in group AC (AC: 0.67 +/- 0.55 vs. Conv: 1.13 +/- 0.82; P = 0.005). Follow-up duration correlated with a decreasing number of reprogramming per year in group Conv (rho = -0.73, P < 0.001). No ventricular output reprogramming was required in group AC. Holter recordings required 0.07 +/- 0.13 reprogramming per year in group Conv, none in group AC (P < 0.001). Holter-detected lead dysfunction prompted re-intervention in one patient of each group. CONCLUSION: Estimated freedom from as well as total yearly rate of device reprogramming was favourable for AC-programmed devices. No difference was seen for the incidence of invasive re-interventions. AC ventricular output control was effective. Structured device follow-up and Holter recordings in specific patient groups remain mandatory for all devices in paediatric patients.