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Patsiou V, Haidich AB, Baroutidou A, Giannopoulos A, Giannakoulas G. Epicardial Versus Endocardial Pacing in Paediatric Patients with Atrioventricular Block or Sinus Node Dysfunction: A Systematic Review and Meta-analysis. Pediatr Cardiol 2023; 44:1641-1648. [PMID: 37480376 PMCID: PMC10520152 DOI: 10.1007/s00246-023-03213-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/14/2023] [Indexed: 07/24/2023]
Abstract
Pacing indications in children are clearly defined, but whether an epicardial (EPI) or an endocardial (ENDO) pacemaker performs better remains to be elucidated. This systematic review and meta-analysis aimed to directly compare the incidence of pacemaker (PM) lead-related complications, mortality, hemothorax and venous occlusion between EPI and ENDO in children with atrioventricular block (AVB) or sinus node dysfunction (SND). Literature search was conducted in MEDLINE (via PubMed), Scopus by ELSEVIER, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and OpenGrey databases until June 25, 2022. Random-effects meta-analyses were performed to assess the pacing method's effect on lead failure, threshold rise, post-implantation infection and battery depletion and secondarily on all-cause mortality, hemothorax and venous occlusion. Several sensitivity analyses were also performed. Of 22 studies initially retrieved, 18 were deemed eligible for systematic review and 15 for meta-analysis. Of 1348 pediatric patients that underwent EPI or ENDO implantation, 542 (40.2%) had a diagnosis of congenital heart disease (CHD). EPI was significantly associated with higher possibility of PM-lead failure [pooled odds ratio (pOR) 3.00, 95% confidence interval (CI) 2.05-4.39; I2 = 0%]; while possibility for threshold rise, post-implantation infection and battery depletion did not differ between the PM types. Regarding the secondary outcome, the mortality rates between EPI and ENDO did not differ. In sensitivity analyses the results were consistent results between the two PM types. The findings suggest that EPI may be associated with increased PM-lead failure compared to ENDO while threshold rise, infection, battery depletion and mortality rates did not differ.
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Affiliation(s)
- Vasiliki Patsiou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Amalia Baroutidou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andreas Giannopoulos
- Second Department of Pediatrics, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ali AN, Wafa SS, Arafa HH, Samir R. Original Article--Outcomes of Pacing in Egyptian Pediatric Population. J Saudi Heart Assoc 2021; 33:61-70. [PMID: 33880330 PMCID: PMC8051327 DOI: 10.37616/2212-5043.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives Permanent pacemakers are widely used in the pediatric population due to congenital and surgically acquired rhythm disturbances. The diversity and complexity of congenital heart diseases make device management a highly individualized procedure in pediatric pacing. We are also faced with special problems in pediatric age group as growth, children’s activity and infection susceptibility. This study aimed to present our institute’s experience in pediatric and adolescent pacemaker implantation and long-term outcomes. Methods This cross-sectional observational study included 100 pediatric patients who visited our outpatient clinics at Ain Shams University Hospitals for regular follow up of their previously implanted permanent pacemakers. All patients were subjected to history taking, clinical examination, ECG recording, echocardiography and elaborate device programming. Data about device types, device components’ longevity, subsequent procedures, complications were collected, with comparison between epicardial and endocardial pacemakers. Results Our study population ranged in age from 8 months to 18 years (mean 13.12 ± 5.04 years), 51 were males and 53 patients had congenital heart disease. Epicardial pacing represented 26% of our total population using only VVIR pacemakers, while endocardial pacing represented 74% of our population with 58.1% of them being VVIR pacemakers. First battery longevity was higher in endocardial batteries (108 months vs. 60 months, p value: 0.007). First lead longevity was also higher in endocardial leads (105 moths vs. 58 months, p value: 0.006). Complication rate was 25%; 8 patients had early complications (one insulation break in endocardial group). Late complications occurred in 17 patients (10 patients had lead fracture; 9 of them were endocardial, 2 insulation breaks in endocardial leads, 3 patients from epicardial group had lead failure of capture). In total, 16 patients had lead-related complications. There was no statistically significant difference between different lead models regarding lead-related complications. Conclusion Pacemakers in children are generally safe, but still having high rates of lead-related complications. Lead failure of capture was more common in epicardial leads. These complications had no relation to the model of the leads. Endocardial pacemakers showed higher first lead and first battery longevity compared to epicardial pacemakers.
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Affiliation(s)
- Ahmed Nabil Ali
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Samir S Wafa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hosni Hosni Arafa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Samir
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ng LY, Gallagher S, Walsh KP. Case series of late lead dislodgement of Medtronic SelectSecure 3830 pacing leads in growing paediatric patients. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytaa545. [PMID: 33598620 PMCID: PMC7873804 DOI: 10.1093/ehjcr/ytaa545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/24/2020] [Accepted: 12/08/2020] [Indexed: 11/13/2022]
Abstract
Background The SelectSecure lumenless 3830 pacing lead is often considered to be the pacing lead of choice for transvenous pacing in children because of its small diameter, lead strength, and reliable long-term sensing and pacing characteristics. One of the potential long-term pitfalls of a sturdy pacing lead is relative retraction with growth in children resulting in late lead dislodgement. Case summary We report two cases of late SelectSecure 3830 lead dislodgement at 11.8 years (Case 1) and 8.8 years (Case 2), respectively, post the initial implantation. Case 1 was diagnosed with congenital complete heart block (CHB) at 9 months old when he presented with unconfirmed diphtheria infection. Case 2 was diagnosed with CHB at 14 weeks of age with positive maternal anti-Ro antibodies. Both patients underwent implantation of a transvenous permanent pacemaker implantation with Medtronic SelectSecure 3830 lead due to symptomatic bradycardia. Apart from a pulse generator change at 8.5 years (Case 1) and 7 years (Case 2), respectively, post-implant due to normal battery depletion, both patients are well in the interim. Discussion As part of the pacemaker follow-up for rapidly growing children, we recommend more frequent surveillance of lead ‘tautness’ by chest radiography especially in children with CHB with no underlying heart rhythm.
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Affiliation(s)
- Li Yen Ng
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Dublin D12 N512, Ireland
| | - Sarah Gallagher
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Dublin D12 N512, Ireland
| | - Kevin P Walsh
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Cooley Road, Crumlin, Dublin D12 N512, Ireland
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Bansal N, Samuel S, Zelin K, Karpawich PP. Ten-Year Clinical Experience with the Lumenless, Catheter-Delivered, 4.1-Fr Diameter Pacing Lead in Patients with and without Congenital Heart. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:17-25. [PMID: 28004408 DOI: 10.1111/pace.12995] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/27/2016] [Accepted: 11/26/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with congenital heart defects (CHD) often present more challenges to pacing therapy due to anatomy than those without CHD. The lumenless, 4.1Fr diameter M3830 pacing lead (Medtronic, Inc., Minneapolis, MN, USA), approved for use in 2005, has, to date, reported to have excellent short-term (<6 years) lead performance. Unfortunately, very long-term performance is unknown, especially among CHD patients and with implants at alternate pacing (AP) sites. This study reports a 10-year clinical experience with the M3830 lead. METHODS Records of patients who received the M3830 lead were reviewed: patient demographics, implant techniques and locations, sensing and pacing characteristics, impedances (Imp), and any complications at implant and follow-up. RESULTS From 2005 to 2015, 141 patients (ages 2-50, mean 20.1 years, 57% males) received 212 leads: atrial 115; ventricle 97. CHD was present in 62% of patients. Leads were inserted at AP sites in 96% of patients. Postimplant follow-up was from 3 months to 10 years (mean 56.3 months). Comparative implant versus follow-up values (mean ± standard deviation) were available on 196 leads (92.5%), showing persistently low (<1 v @ 0.4-0.5 ms) pacing thresholds (P = 0.57). Sensing was also comparable (atrial leads, P = 0.41; ventricular leads, P = 0.9). Impedances differed (P < 0.05) but remained within the normal range. Two A leads became dislodged and one was repositioned while two other leads (1 A, 1 V) were extracted. There are no differences observed in the pacing characteristics between the CHD and non-CHD groups on follow-up. CONCLUSIONS The 4.1Fr lumenless pacing lead shows ease of implant regardless of CHD or AP site, excellent very long-term (10 years) stability, and performance indices with a very low rate of complications.
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Affiliation(s)
- Neha Bansal
- Section of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Sharmeen Samuel
- Section of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Kathleen Zelin
- Section of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
| | - Peter P Karpawich
- Section of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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Abstract
Despite significant advances in the pharmacological treatment of heart failure, rates of mortality and morbidity from the condition remain a concern. The introduction of cardiac resynchronisation therapy (CRT) has been a welcome addition to the treatment strategy of patients who display ventricular dyssynchrony. Several control studies have shown significant benefits from this intervention in particular improved mortality and reduction in symptom burden. In this short review, we focus on several concepts of CRT and discuss the implications of surgical implantation of the left ventricular (LV) lead as compared to the standard transvenous approach.
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Affiliation(s)
- S M Shaw
- North West Regional Cardiac and Transplant Unit, University Hospital of South Manchester, NHS Hospitals Foundation Trust, Manchester, UK
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Zhang T, Liu Y, Zou C, Zhang H. Single chamber permanent epicardial pacing for children with congenital heart disease after surgical repair. J Cardiothorac Surg 2016; 11:61. [PMID: 27067028 PMCID: PMC4828884 DOI: 10.1186/s13019-016-0439-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/03/2016] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the 10-year experience of single chamber permanent epicardial pacemaker placement for children with congenital heart diseases (CHD) after surgical repair. Methods Between 2002 and 2014, a total of 35 patients with CHD (age: 26.9 ± 23.2 months, weight: 9.7 ± 5.6 kg) received permanent epicardial pacemaker placement following corrective surgery. Echocardiography and programming information of the pacemaker, as well as major adverse cardiac events (MACE) as heart failure or sudden death, were recorded during follow-up (46.8 ± 33.8 months). Results Acute ventricular stimulation threshold was 1.34 ± 0.72 V and no significant increase was observed at the last follow-up as 1.37 ± 0.81 V (p = 0.93). Compared with initial pacemaker implantation, the last follow-up didn’t show significant increases in impedance (p = 0.327) or R wave (p = 0.635). Four patients received pacemaker replacement because of battery depletion. 7/35 (20 %) of patients experienced MACE. Although the age and body weight were similar between patients with and without MACE, the patients with MACE were with complex CHD (100 % vs.55.6 %, p = 0.04). Conclusion High-degree iatrogenic atrioventricular block was the primary reason for placement of epicardial pacemaker for patients with CHD after surgical repair. Pacemaker placement with the steroid-eluting leads results in acceptable outcomes, however, the pacemaker type should be optimized for the children with complex CHD.
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Affiliation(s)
- Tao Zhang
- Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.,Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China.,Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shouguang, China
| | - Yiwei Liu
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Chengwei Zou
- Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China.
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China. .,Peking Union Medical College and Chinese Academy of Medical Sciences, 167 Beilishi Road, Beijing, 100037, P.R. China.
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Saad TF, Hentschel DM, Koplan B, Wasse H, Asif A, Patel DV, Salman L, Carrillo R, Hoggard J. Cardiovascular Implantable Electronic Device Leads in CKD and ESRD Patients: Review and Recommendations for Practice. Semin Dial 2012; 26:114-23. [DOI: 10.1111/j.1525-139x.2012.01103.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Samir R, Diab OA, Morttada A, Aboulmaaty M. Permanent pacing in infants and children: A single center experience in implantation and follow up. Egypt Heart J 2011. [DOI: 10.1016/j.ehj.2011.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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KHAN ASRA, ZELIN KATHLEEN, KARPAWICH PETERP. Performance of the Lumenless 4.1-Fr Diameter Pacing Lead Implanted at Alternative Pacing Sites in Congenital Heart: A Chronic 5-Year Comparison. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1467-74. [DOI: 10.1111/j.1540-8159.2010.02884.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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STOJANOV PETARL, SAVIC DRAGUTINV, ZIVKOVIC MIRJANAB, CALOVIC ZARKOR. Permanent Endovenous Pediatric Pacing: Absence of Lead Failure-20 Years Follow-Up Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1100-7. [DOI: 10.1111/j.1540-8159.2008.01148.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Tomaske M, Harpes P, Woy N, Bauersfeld U. The efficacy of ventricular pacing with device automaticity in paediatric patients. Europace 2008; 10:838-43. [DOI: 10.1093/europace/eun038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Olgun H, Karagoz T, Celiker A, Ceviz N. Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker. Europace 2008; 10:844-7. [DOI: 10.1093/europace/eun109] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Al Sabti H, Menon RG, Maddali MM, Valliattu J. Wandering permanent pacemaker generators in children: a case series. J Med Case Rep 2008; 2:163. [PMID: 18485236 PMCID: PMC2396653 DOI: 10.1186/1752-1947-2-163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 05/18/2008] [Indexed: 11/24/2022] Open
Abstract
Introduction Epicardial permanent pacemaker generators are implanted some times in the abdominal wall in pediatric age groups. Case presentation Three permanent epicardial pacemakers that migrated in an unusual manner producing intraabdominal complications are reported. Conclusion The different clinical presentations of pacemaker migration in the pediatric age groups are highlighted and a few suggestions are made for avoiding such a complication.
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Affiliation(s)
- Hilal Al Sabti
- Department of Cardiothoracic Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
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Fukuda Y, Yoshida T, Inage T, Takeuchi T, Nagamoto Y, Gondo T, Imaizumi T. Implantation of pacemaker for sick sinus syndrome in a patient with persistent left superior vena cava and absent right superior vena cava. Heart Vessels 2008; 23:206-8. [DOI: 10.1007/s00380-007-1032-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Kammeraad JAE, Rosenthal E, Bostock J, Rogers J, Sreeram N. Endocardial Pacemaker Implantation in Infants Weighing <= 10 Kilograms. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 27:1466-74. [PMID: 15546300 DOI: 10.1111/j.1540-8159.2004.00663.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.
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Horenstein MS, Hakimi M, Walters H, Karpawich PP. Chronic performance of steroid-eluting epicardial leads in a growing pediatric population: a 10-year comparison. Pacing Clin Electrophysiol 2003; 26:1467-71. [PMID: 12914623 DOI: 10.1046/j.1460-9592.2003.t01-1-00212.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patient size and congenital heart defects complicate pacemaker therapy in children favoring an initial epicardial approach. Steroid-eluting (SE) epicardial (EPI) leads maintain stable, low pacing thresholds in the short-term when compared to the nonsteroid (NSE) epicardial (EPI) leads. The purpose of this study was to evaluate chronic, 10-year performance of SE leads in growing children compared with NSE EPI leads implanted during the same time interval. From 1990 to 2000, 35 patients (age 1 month to 18 year, median 3 years), 28 with and 7 without congenital heart disease (CHD) received 51 SE leads: 27 ventricular and 24 atrial. NSE leads were implanted in 27 patients (age 1-28 years, median 8 years), 24 with and 3 without CHD: 27 ventricular and 1 atrial. Pacing lead threshold, impedance, and energy were measured at implant and during a 10-year follow-up. Unpaired t-test showed that impedance remained stable for all leads with lower mean values for the SE(376 +/- 55 vs 443 +/- 109 Omega) (P = NS). The mean energy requirement for SE leads at 10 years(1.2 +/- 0.9 microJ)was significantly lower than for NSE(4.4 +/- 5.5 microJ) (P < 0.05). At 2.5-V output, chronic thresholds for SE leads did not significantly differ from implant values for atrial (0.08 vs 0.09 ms) or ventricular (0.08 vs 0.08 ms) sites. There were no differences in SE lead performances among patients with or without CHD. Fracture or dislodgement occurred in two SE (4%) and four NSE (14%) leads. SE outperform NSE EPI leads and show stable, chronic low thresholds over time in all growing children.
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Affiliation(s)
- M Silvana Horenstein
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Costa R, Filho MM, Tamaki WT, Crevelari ES, Nishioka SD, Moreira LFP, Oliveira SA. Transfemoral pediatric permanent pacing: long-term results. Pacing Clin Electrophysiol 2003; 26:487-91. [PMID: 12687874 DOI: 10.1046/j.1460-9592.2003.00078.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The femoral vein has been used as an alternative conduit to implant pacemakers in children of any weight. Such method associates endocardial pacing and good cosmetics. The aim of this study was to evaluate prospectively, since 1981, the long-term follow-up of 99 children, from newborn to 13 years old (average = 4.1 +/- 3.6 years, 56 girls), who underwent the implantation of pacemakers via the femoral vein. Atrioventricular block was present in 88% of patients, of congenital etiology in 39% and postoperative in 54%. Single chamber pacemakers were implanted in 92% of patients. During a mean follow-up of 5.3 +/- 5.0 years (maximum = 18.2 years), 5 patients died of cardiac causes, 4 of infection, 2 suddenly, and 3 of unknown causes. The 5-, 10- and 15-year actuarial survival rates were 83.7%, 75.7%, and 75.7%, respectively. Transfemoral leads were used for a mean of 48.9 +/- 44.0 months. Reasons for lead explantations were pacing failure in five patients, infection in eight, and elective in nine. The 2-, 5- and 10-year actuarial survivals of transfemoral leads were 87.6%, 73.8%, and 31.8%, respectively. The mean lead survival was 97 months. Overall, 105 reoperations were performed, 38 for battery depletion, 24 for body growth, 14 for infection or pocket revisions, and 27 for miscellaneous reasons. In conclusion, the durability and overall long-term performance of transfemoral leads were excellent.
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Affiliation(s)
- Roberto Costa
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil.
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Rosenheck S, Leibowitz D, Sharon Z. Three-year follow-up of atrial sensing efficacy in children and adults with a single lead VDD pacing system. Pacing Clin Electrophysiol 2000; 23:1226-31. [PMID: 10962743 DOI: 10.1111/j.1540-8159.2000.tb00935.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate the efficacy of atrial sensing in children with a single pass lead VDD pacing system and to compare it with the efficacy of atrial sensing in adult patients with the same pacing system. Although the feasibility of single pass lead VDD pacing system implantation in children was recently demonstrated, the efficacy of atrial sensing remains unclear. In addition, the effect of accelerated growth of children on the systems' efficacy has not been addressed. Atrial sensing followed by ventricular sensing and atrial sensing followed by ventricular pacing was prospectively evaluated in 13 children (age 0.5-15 years) and 24 adult patients (age 19-74 years). All had the same endocardial pacing system using a single pass lead. The children and adults had effective atrial sensing at a success rate of 94.00 +/- 9.687% and 96.04 +/- 4.64%, respectively, during mean follow-up of 3.5 years. The atrial electrogram amplitude was similar in both groups, 1.8 +/- 1.5 mV in children and 1.8 +/- 1.1 mV in adults. The adult patients more frequently exhibited ventricular sensing following atrial sensing. The ventricular pacing threshold and impedance were stable in both groups. When necessary, in children, the atrial sensing was corrected by adjusting the pacemaker's lower rate programming. Highly effective atrial sensing was demonstrated in children and adult patients with a single pass lead VDD pacing system. During a mean follow-up of 3.5 years, not only was the atrial electrogram amplitude stable, but the clinically relevant atrial sensing was highly effective, justifying endocardial pacing with single pass lead VDD pacing in children and adults with preserved sinus node function.
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Affiliation(s)
- S Rosenheck
- Cardiology Unit, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel.
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Maginot KR, Mathewson JW, Bichell DP, Perry JC. Applications of pacing strategies in neonates and infants. PROGRESS IN PEDIATRIC CARDIOLOGY 2000; 11:65-75. [PMID: 10822191 DOI: 10.1016/s1058-9813(00)00037-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pacing in neonates and infants continues to be challenging due to size constraints, growth potential, and the need for life long pacing. Indications for permanent pacing in pediatric patients have been difficult to determine due to the lack of data from controlled studies and multicenter trials. Temporary pacing has been useful to restore cardiac output in pediatric patients quickly and efficiently. Methods of temporary pacing include transcutaneous, transesophageal, transvenous, and epicardial. Permanent pacemaker implantation can be accomplished by transvenous or epicardial approaches, but the use of transvenous pacing in neonates and infants offers no advantages over epicardial pacing. Transvenous pacing in infants is often prohibitive due to size and growth constraints as well as the subsequent risk of skin erosion and venous thrombosis. Smaller pulse generators, multiprogrammable features, and steroid-eluting epicardial leads are a few of the technological advances that have made pacing in neonates and infants easier and safer. Data supporting the use of pacing systems in very young patients are sparse. Pacing 'indications' should be viewed as guidelines until such data can be accumulated.
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Affiliation(s)
- KR Maginot
- Children's Hospital San Diego, Division of Cardiology, San Diego, CA, USA
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Beaufort-Krol GC, Mulder H, Nagelkerke D, Waterbolk TW, Bink-Boelkens MT. Comparison of longevity, pacing, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children. J Thorac Cardiovasc Surg 1999; 117:523-8. [PMID: 10047656 DOI: 10.1016/s0022-5223(99)70332-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Because of either cardiac anatomy or small size, pacing in children often occurs by means of epicardial leads. The disadvantage of epicardial leads is the shorter longevity of these leads compared with endocardial leads. During short-term follow-up, improved stimulation thresholds were found for the newer steroid-eluting epicardial leads. The longevity of these leads may be better than that of conventional epicardial leads. An improved longevity of epicardial leads may influence the choice to either epicardial or endocardial pacing in children. METHODS We studied the longevity and the pacing and sensing characteristics of 33 steroid-eluting epicardial pacing leads (group I, 15 atrial, 18 ventricular) implanted between November 1991 and October 1996 in 20 children with a mean age of 7.6 +/- 6.5 years (mean +/- SD), and 29 endocardial pacing leads (group II, 15 atrial, 14 ventricular) implanted during the same period in 21 children with a mean age of 11.7 +/- 4.7 years. RESULTS The mean follow-up in group I was 2.9 +/- 1.6 years and in group II 3.1 +/- 1.7 years (P =.61). The 2-year survival of the leads in group I was 91% +/- 5% and in group II 86% +/- 7% (P =.97). Lead failure occurred in both groups in 4 leads (P =.85). Chronic stimulation and sensing thresholds were similar. CONCLUSIONS Steroid-eluting epicardial leads have the same longevity as the conventional endocardial leads. Pacing and sensing thresholds were similar and did not change during follow-up. Therefore steroid-eluting epicardial pacing leads are a good alternative for endocardial leads in small children and in children with congenital heart disease.
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Affiliation(s)
- G C Beaufort-Krol
- Beatrix Children's Hospital, Division of Pediatric Cardiology, and Thoracic Center, University of Groningen, Groningen, The Netherlands
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Schrepf R, Tollens M, Vogt M. [Not Available]. Herzschrittmacherther Elektrophysiol 1998; 9 Suppl 1:122-123. [PMID: 19484576 DOI: 10.1007/bf03042465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- R Schrepf
- III. Medizinische Abteilung des Städtisches Krankenhaus München Harlaching, Lehrkrankenhaus der LMU-München, München, Deutschland
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Rosenheck S, Elami A, Amikam S, Erdman S, Ovsyshcher IE. Single pass lead VDD pacing in children and adolescents. Pacing Clin Electrophysiol 1997; 20:1961-6. [PMID: 9272534 DOI: 10.1111/j.1540-8159.1997.tb03602.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Implantation of permanent pacemakers in children and adolescents is possible but usually is limited to single chamber generators. The natural growth of these patients may require physiological pacing, but until recently two leads were required for this type of pacing. The single pass lead VDD pacing mode makes possible physiological pacing by using only one lead, for both atrial sensing and ventricular sensing and pacing. The feasibility of VDD pacing using endocardial lead was evaluated in 16 children and adolescents with congenital or postsurgical atrioventricular block. Their mean age was 7.9 +/- 4.9 years (range 1-16 years) and the smallest patient's weight was 8.2 kg. In all the patients, a single pass pacing lead with atrial sensing rings and bipolar ventricular pacing and sensing capability was implanted through the left or right subclavian vein. The pacemaker generator was implanted in a rectopectoral position. The mean atrial electrogram during the implantation was 4.2 +/- 2.1 mV and 2.6 +/- 1.9 mV after a mean of 1 week. The ventricular pacing threshold was 0.5 +/- 0.2 V; the ventricular pacing impedance was 560 +/- 95 omega; and the ventricular electrogram amplitude was 9.9 +/- 2.1 mV. This is a first report to demonstrate the feasibility of atrial synchronous ventricular endocardial pacing using a single pass lead in a relatively large group of children and adolescents.
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Affiliation(s)
- S Rosenheck
- Cardiology Unit, Hadassah University Hospital Mount Scopus, Jerusalem, Israel
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Gomez C, Dick M, Hernandez R, Coran AG, Crowley D, Serwer GA. Peritoneal migration of an abdominally implanted epicardial pacemaker: a cause of intestinal obstruction. Pacing Clin Electrophysiol 1995; 18:2231-2. [PMID: 8771141 DOI: 10.1111/j.1540-8159.1995.tb04655.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the case of a 10-year-old child with an abdominally implanted epicardial pacemaker that eroded through the peritoneum and migrated to an intraperitoneal location, resulting in partial and then complete intestinal obstruction. This potentially life-threatening complication should be considered when a patient with an abdominally implanted pacemaker presents with abdominal pain.
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Affiliation(s)
- C Gomez
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA
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Kochiadakis GE, Skalidis EI, Chryssostomakis SI, Kalaitzakis MP, Manios EG, Vardas PE. Evaluation of the reliability of ST segment monitoring by transtelephonic electrocardiogram transmission. Int J Cardiol 1994; 46:267-73. [PMID: 7814180 DOI: 10.1016/0167-5273(94)90249-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Transtelephonic electrocardiographic transmission is a diagnostic technique which has been systematically applied in recent years, mainly for the detection of arrhythmias or pacemaker malfunction. The purpose of this study was to assess the efficacy of this method in the recording and transmission of ST segment and T wave changes. METHOD A Bruce protocol exercise stress test was carried out in 47 consecutive patients (39 males, eight females, age 53.1 +/- 11.5 years) with suspected coronary artery disease (CAD). At the same time, a transtelephonic ECG system, with a 2-min memory and the capability for 16.5 days continuous recording, was used to transmit the ECG (modified leads II and V5). RESULTS A positive ST segment shift was observed in 19 patients (40.4%) during the exercise test. The transtelephonic system recorded this change in 18 of these patients but missed the anteroseptal ST segment depression (V2-V4) in one patient (sensitivity 94.7%). All of the 23 patients with no ST segment changes during the exercise test had a negative transtelephonic ECG transmission (specificity 100%). The width of the ST depression recorded from modified lead II on the transtelephonic recording was not significantly different from that of the 12-lead ECG. The same was true for modified lead V5. CONCLUSION Transtelephonic ECG transmission in patients with suspected CAD can significantly contribute to the investigation of this problem, since the method has high sensitivity and specificity. The capacity for continuous recording and the memory of the device make possible the monitoring of high risk patients for a good length of time.
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Affiliation(s)
- G E Kochiadakis
- Cardiology Clinic, University Hospital of Heraklion, Crete, Greece
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Meijboom F, Hess J, Szatmari A, Utens EM, McGhie J, Deckers JW, Roelandt JR, Bos E. Long-term follow-up (9 to 20 years) after surgical closure of atrial septal defect at a young age. Am J Cardiol 1993; 72:1431-4. [PMID: 8256739 DOI: 10.1016/0002-9149(93)90192-f] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To assess the long-term cardiac status after surgical closure of an atrial septal defect (ASD) at a young age, 104 of 135 children who consecutively underwent surgery (aged 0 to 14 years) at 1 institution between 1968 and 1980 participated in a follow-up study and underwent a complete cardiologic examination. Mean follow-up was 14.5 +/- 2.8 years. Most patients (87%) believed their health to be good or very good. At physical examination, all patients were in good health. Ninety-three patients (89%) were in sinus rhythm. Echocardiography showed that right ventricular dilatation was present in 27 patients (26%), 2 of whom had a residual ASD. Bicycle ergometry revealed that 88 patients (88%) had a normal exercise capacity. Both supraventricular and ventricular arrhythmias were observed in 67% of patients by 24-hour ambulatory electrocardiography, but only 3 (3%) had received antiarrhythmic medication, and 4 (4%) had needed a pacemaker. In the group of patients with right ventricular dilatation, the exercise capacity and prevalence of arrhythmias did not differ significantly from those in the group with a normal sized right ventricule. The outcome in patients with a secundum-type ASD was not different from that of those with a sinus venosus-type ASD. The finding of anatomic, functional or electrophysiologic abnormalities was not associated with a longer duration of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- F Meijboom
- Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands
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Lau YR, Gillette PC, Buckles DS, Zeigler VL. Actuarial survival of transvenous pacing leads in a pediatric population. Pacing Clin Electrophysiol 1993; 16:1363-7. [PMID: 7689200 DOI: 10.1111/j.1540-8159.1993.tb01729.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study was undertaken to examine the actuarial survival of endocardial pacing leads in a pediatric population. We prospectively followed 148 children and young adults age 4 months to 38 years. Of these, 58 had normal cardiac anatomy and 90 had surgically corrected congenital heart disease. A total of 213 leads were inserted in these patients. Actuarial analysis showed that at 5 years 76.0% of the pacemaker leads were still in use. The reasons for abandonment included death (10), exit block (8), lead fracture (8), adapter malfunction (7), and other including infection, lead migration, and pacemaker malfunction (12). Excluding deaths, an actuarial survival curve was constructed. Stepwise discriminant analysis and independent measures of association showed a significant difference in lead abandonment when the leads placed in the atrium were compared to those placed in the ventricle (30 vs 5; P < 0.0005). Lead insulating material, cardiac anatomy, and/or indication for pacemaker placement had no statistically significant impact on lead survival.
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Affiliation(s)
- Y R Lau
- Medical University of South Carolina, South Carolina Children's Heart Center, Charleston 29425
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