(Circulation. 2001;103:2585.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Permanent Epicardial Pacing in Pediatric Patients
Seventeen Years of Experience and 1200 Outpatient Visits
Presented in part at the 73rd Scientific Sessions of the American Heart Association, New Orleans, La, November 12–15, 2000.
From the Divisions of Cardiology (M.I.C., D.M.B., V.L.V., R.E.T., T.S.W., L.A.R.) and Cardiothoracic Surgery (J.W.G.) and the Departments of Pediatrics (M.I.C., D.M.B., V.L.V., R.E.T., T.S.W., L.A.R.) and Surgery (J.W.G.), The Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia.
Correspondence to Mitchell I. Cohen, MD, Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104.
Background—The purpose of this study was to evaluate the long-term outcome of all pediatric epicardial pacing leads.
Methods and Results—All epicardial leads and 1239 outpatient visits between January 1, 1983, and June 30, 2000, were retrospectively reviewed. Pacing and sensing thresholds were reviewed at implant, at 1 month, and at subsequent 6-month intervals. Lead failure was defined as the need for replacement or abandonment due to pacing or sensing problems, lead fracture, or phrenic/muscle stimulation. A total of 123 patients underwent 207 epicardial lead (60 atrial/147 ventricular, 40% steroid) implantations (median age at implant was 4.1 years [range 1 day to 21 years]). Congenital heart disease was present in 103 (84%) of the patients. Epicardial leads were followed for 29 months (range 1 to 207 months). The 1-, 2-, and 5-year lead survival was 96%, 90%, and 74%, respectively. Compared with conventional epicardial leads, both atrial and ventricular steroid leads had better stimulation thresholds 1 month after implantation; however, only ventricular steroid leads had improved chronic pacing thresholds (at 2 years: for steroid leads, 1.9 µJ [from 0.26 to 16 µJ]; for nonsteroid leads, 4.7 µJ [from 0.6 to 25 µJ]; P<0.01). Ventricular sensing was significantly better in steroid leads 1 month after lead implantation (at 2 years: for steroid leads, 8 mV [from 4 to 31 mV]; for nonsteroid leads, 4 mV [from 0.7 to 10 mV]; P<0.01). Neither congenital heart disease, lead implantation with a concomitant cardiac operation, age or weight at implantation, nor the chamber paced was predictive of lead failure.
Conclusions—Steroid epicardial leads demonstrated relatively stable acute and chronic pacing and sensing thresholds. In this evaluation of >200 epicardial leads, lead survival was good, with steroid-eluting leads demonstrating results similar to those found with historical conventional endocardial leads.
Key Words: electrocardiography • pacemakers • pediatrics
This article has been cited by other articles:
 |
|
 |
|
  A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
 |
|
 A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Odim, B. Suckow, B. Saedi, H. Laks, and K. Shannon Equivalent Performance of Epicardial Versus Endocardial Permanent Pacing in Children: A Single Institution and Manufacturer Experience Ann. Thorac. Surg., April 1, 2008; 85(4): 1412 - 1416. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Murayama, M. Maeda, H. Sakurai, A. Usui, and Y. Ueda Predictors affecting durability of epicardial pacemaker leads in pediatric patients. J. Thorac. Cardiovasc. Surg., February 1, 2008; 135(2): 361 - 366. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Tomaske, P. Harpes, A. Dodge-Khatami, N. Amacker, and U. Bauersfeld Do daily threshold trend fluctuations of epicardial leads correlate with pacing and sensing characteristics in paediatric patients? Europace, August 1, 2007; 9(8): 662 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. P. Walsh Interventional Electrophysiology in Patients With Congenital Heart Disease Circulation, June 26, 2007; 115(25): 3224 - 3234. [Full Text] [PDF]
|
|
|
|
|
|
M. S. Silvetti, F. Drago, A. De Santis, G. Grutter, L. Rava, L. Monti, and R. Fruhwirth Single-centre experience on endocardial and epicardial pacemaker system function in neonates and infants Europace, June 1, 2007; 9(6): 426 - 431. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. C. Aellig, C. Balmer, A. Dodge-Khatami, M. Rahn, R. Pretre, and U. Bauersfeld Long-Term Follow-Up After Pacemaker Implantation in Neonates and Infants Ann. Thorac. Surg., April 1, 2007; 83(4): 1420 - 1423. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Silvetti, F. Drago, G. Grutter, A. De Santis, V. Di Ciommo, and L. Rava Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients Europace, July 1, 2006; 8(7): 530 - 536. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-J. Hsieh, K.-H. Yeh, O. S. Satish, and C.-C. Wang Permanent pacing using a coronary sinus lead in a patient with univentricular physiology: an extended application of biventricular pacing technology. Europace, February 1, 2006; 8(2): 147 - 150. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Gabor, G. Prenner, A. Wasler, M. Schweiger, K. H. Tscheliessnigg, and F. M. Smolle-Juttner A simplified technique for implantation of left ventricular epicardial leads for biventricular resynchronisation using video-assisted thoracoscopy (VATS) Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 797 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Navia, F. A. Atik, R. A. Grimm, M. Garcia, P. R. Vega, U. Myhre, R. C. Starling, B. L. Wilkoff, D. Martin, P. L. Houghtaling, et al. Minimally Invasive Left Ventricular Epicardial Lead Placement: Surgical Techniques for Heart Failure Resynchronization Therapy Ann. Thorac. Surg., May 1, 2005; 79(5): 1536 - 1544. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Bove and K. Francois Invited commentary Ann. Thorac. Surg., July 1, 2004; 78(1): 202 - 203. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Puglisi, M. Lunati, A. G.M Marullo, S. Bianchi, M. Feccia, F. Sgreccia, I. Vicini, S. Valsecchi, F. Musumeci, and E. Vitali Limited thoracotomy as a second choice alternative to transvenous implant for cardiac resynchronisation therapy delivery Eur. Heart J., June 2, 2004; 25(12): 1063 - 1069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Walker, S. C. Siu, S. Woods, D. A. Cameron, G. D. Webb, and L. Harris Long-Term outcomes of cardiac pacing in adults with congenital heart disease J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1894 - 1901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. R. Thomson, M. E. Blackburn, C. Van Doorn, A. Nicholls, and K. G. Watterson Pacing activity, patient and lead survival over 20 years of permanent epicardial pacing in children Ann. Thorac. Surg., April 1, 2004; 77(4): 1366 - 1370. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. I. Cohen, K. Buck, R. E. Tanel, V. L. Vetter, L. A. Rhodes, J. Cox, T. Sheldon, and L. Ruetz Capture management efficacy in children and young adults with endocardial and unipolar epicardial systems, Europace, January 1, 2004; 6(3): 248 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-L. Jansens, M. Jottrand, N. Preumont, E. Stoupel, and D. de Canniere Robotic-enhanced biventricular resynchronization: an alternative to endovenous cardiac resynchronization therapy in chronic heart failure Ann. Thorac. Surg., August 1, 2003; 76(2): 413 - 417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-H. Nurnberg, H. Abdul-Khaliq, P. Ewert, and P. E. Lange Antibradycardia pacing in patients with congenital heart disease: experience with automatic threshold determination and output regulation (AutocaptureTM) Europace, January 1, 2003; 5(2): 199 - 205. [Abstract] [PDF]
|
|
|
|
|
|
M. I. Cohen, D. M. Bush, J. W. Gaynor, V. L. Vetter, R. E. Tanel, and L. A. Rhodes Pediatric pacemaker infections: Twenty years of experience J. Thorac. Cardiovasc. Surg., October 1, 2002; 124(4): 821 - 827. [Abstract] [Full Text] [PDF]
|
|