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Karim F, Peck D, Narasimhan S, Von Bergen NH. Epicardial Implantation of a Micra™ Pacemaker in a Premature Neonate with Congenital Complete Heart Block. J Innov Card Rhythm Manag 2024; 15:5739-5743. [PMID: 38304090 PMCID: PMC10829414 DOI: 10.19102/icrm.2024.15012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/28/2023] [Indexed: 02/03/2024] Open
Abstract
Pacemaker implantation in neonates can be challenging due to their small size. Even pulse generators adapted for pediatric patients, such as the Microny device (Abbott, Chicago, IL, USA), are proportionately large in comparison to the size of the smallest newborns. Due to anatomic considerations, such as small vascular and ventricular sizes, leadless pacemakers and transvenous implantation in the youngest neonatal population remain unsuitable. Even so, the desire for leadless devices has prompted the industry to create the smallest pacemakers available. Adapting the smaller Micra™ transcatheter leadless pacing system (Medtronic, Minneapolis, MN, USA) for an epicardial pacing application may be advantageous to the smallest patients. This case illustrates the use of a Micra™ device modified with a header block to serve as the pulse generator in a ventricular epicardial pacing system for a 1-day-old, 2.68-kg patient with complete heart block.
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Affiliation(s)
- Farida Karim
- Pediatric Cardiology Department, Masonic Children’s Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Peck
- Pediatric Cardiology Department, Masonic Children’s Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Shanti Narasimhan
- Pediatric Cardiology Department, Masonic Children’s Hospital, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas H. Von Bergen
- Pediatric Cardiology Department, Masonic Children’s Hospital, University of Minnesota, Minneapolis, MN, USA
- Pediatric Cardiology Department, The University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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2
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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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3
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Congenital atrioventricular heart block: From diagnosis to treatment. Rev Port Cardiol 2022; 41:231-240. [DOI: 10.1016/j.repc.2019.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 09/23/2019] [Indexed: 11/22/2022] Open
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Khairy P, Mondésert B, Mongeon FP, Poirier N, Thibault B. Leadless atrioventricular synchronous pacing in Eisenmenger syndrome. HeartRhythm Case Rep 2021; 7:538-541. [PMID: 34434703 PMCID: PMC8377262 DOI: 10.1016/j.hrcr.2021.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paul Khairy
- Adult Congenital Heart Disease Center.,Electrophysiology Service
| | | | | | - Nancy Poirier
- Adult Congenital Heart Disease Center.,Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Canada
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Termosesov S, Kulbachinskaya E, Polyakova E, Khaspekov D, Grishin I, Bereznitskaya V, Shkolnikova M. Video-assisted thoracoscopic pacemaker lead placement in children with atrioventricular block. Ann Pediatr Cardiol 2020; 14:67-71. [PMID: 33679063 PMCID: PMC7918012 DOI: 10.4103/apc.apc_93_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/07/2020] [Accepted: 03/19/2020] [Indexed: 12/01/2022] Open
Abstract
Background: The pacemaker lead placement is presented as one of the most appropriate procedures in children with a complete atrioventricular block (AVB). Despite the fact that video-assisted thoracic surgery (VATS) for epicardial lead placement has demonstrated positive results as to the feasibility, safety, and efficacy in adults, its role in pacemaker implantation in children remains unclear. Aim: This study sought to assess the intermediate-term outcomes of video-assisted thoracoscopic pacemaker lead placement in children with complete AVB Materials and Methods: From May 2017 to November 2019, five children with complete AVB underwent minimally invasive left ventricular (LV) lead placements via thoracoscopic video assistance approach. The procedure was performed under complex intratracheal anesthesia with single-lung ventilation, all pacing parameters were evaluated in perioperative and follow-up periods. Results: The median age of children at implantation was 3 years (range: 2 to 4 years), the median weight was 13 kg (range: 12–15 kg). All procedures were completed successfully, pacing thresholds for the active lead measured 0.3-1.1V, with R-wave amplitude of 8-18 mV and impedance of 560-1478 Ohm. Conclusion: Thoracoscopic pacemaker lead placement may provide a potential alternative to the transthoracic approach of epicardial lead placement in children with AVB.
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Affiliation(s)
- Sergey Termosesov
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ekaterina Kulbachinskaya
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ekaterina Polyakova
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Dmitriy Khaspekov
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Ivan Grishin
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Vera Bereznitskaya
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Maria Shkolnikova
- Children's Aenter of arrhythmias, Veltischev Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
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Clark BC, Kumthekar R, Mass P, Opfermann JD, Berul CI. Chronic performance of subxiphoid minimally invasive pericardial Model 20066 pacemaker lead insertion in an infant animal model. J Interv Card Electrophysiol 2019; 59:13-19. [PMID: 31612301 DOI: 10.1007/s10840-019-00626-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe chronic performance of subxiphoid minimally invasive pacemaker lead insertion in a piglet model. METHODS Minimally invasive pacemaker lead implantation was performed through a 10-mm incision under direct visualization using the PeriPath port. Epicardial access was obtained and the commercially available Medtronic Model 20066 pacemaker lead was inserted into the pericardial space and epicardial fixation was performed using the side-action helix. The lead was connected to a pacemaker generator in a para-rectus pocket. Animals underwent a 12-14-week observation period and lead impedances, R-wave amplitudes, and ventricular capture thresholds were tested biweekly. After the survival period, animals were euthanized and gross and histopathology were performed. RESULTS Subxiphoid minimally invasive pacemaker lead placement was performed in 8 animals (median 4.9 kg) with 100% acute success. Median procedure time was 65 min (IQR 60.5-77). At implant, median lead impedance was 650 Ω (IQR 244-984), R-wave amplitude 11.1 mV (IQR 8-12.3), and ventricular capture threshold 1.5 V @ 0.4 ms (IQR 1-2.6). Over a median survival period of 13 weeks, there was a median lead impedance change of + 262 Ω (IQR 5.3-618.3), R-wave change of - 4.5 mV (IQR - 7.1-- 2.7) and capture threshold change (1.0 ms) of + 1.5 V (IQR 0-3.3). At autopsy, epicardial fixation sites showed fibrovascular proliferation and minimal chronic inflammation. CONCLUSIONS Subxiphoid pericardial pacemaker placement is safe and effective in a piglet model. Further study and development of leads designed for pericardial placement are warranted.
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Affiliation(s)
- Bradley C Clark
- Children's Hospital at Montefiore, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA
| | - Justin D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA
| | - Charles I Berul
- Children's National Medical Center, Washington, DC, USA.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Washington, DC, USA.,George Washington University School of Medicine, Washington, DC, USA
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