Actuarial Survival of Transvenous Pacing Leads in a Pediatric Population

Lau, Yung R.; Gillette, Paul C.; Buckles, David S.; Zeigler, Vicki L.

doi:10.1111/j.1540-8159.1993.tb01729.x

Cited by 43 publications

(27 citation statements)

References 12 publications

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“…8,26 The overall 5-year epicardial lead survival in the present study was 74% and compares reasonably well with reported conventional endocardial systems. 9,20 Although improved lead survival may be achieved with steroid endocardial leads, no long-term lead comparisons have been performed between steroid epicardial and endocardial leads. Unique to the present study was the observation of zero lead failure with subxiphoid leads.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] The increased pacing thresholds associated with epicardial leads have reduced lead longevity. 3,8 Although endocardial pacing systems have demonstrated acceptable midterm sensing and pacing characteristics, 9 concern has been raised about longterm vascular and/or valvular integrity with multiple transvenous leads. 10,11 Recent advances in lead technology and surgical approach, such as steroid epicardial leads and left atrial leads, have demonstrated encouraging early sensing and pacing qualities when used in children.…”

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confidence: 99%

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Permanent Epicardial Pacing in Pediatric Patients

et al. 2001

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Permanent Epicardial Pacing in Pediatric Patients

et al. 2001

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“…Morbidity and mortality due to AV-block have furthermore been decreased by development of practically feasible pacemaker technologies [4][5][6]. However, pacemaker implantation in paediatric patients is in itself still associated with significant morbidity due to pacemaker malfunction, infection and thrombosis as well as battery-and lead replacement and upgrade of existing systems [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Pacemaker implantation after congenital heart surgery: risk and prognosis in a population-based follow-up study

Smerup

Hjertholm

Johnsen

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: Although earlier a feared complication of congenital cardiac surgery, the incidence of heart-block and sinus node dysfunction has been lowered to 1-4% due to improved surgical techniques and better anatomical understanding of the cardiac conduction system. Development of feasible pacemaker technologies has further lowered mortality and morbidity. However, pacemaker implantation in paediatric patients is in itself associated with significant morbidity due to pacemaker system failure and replacement. The aim of the present study was to examine prognostic factors of mortality, failure of systems and timing of implantation after surgery in post-surgical pacemaker patients. Methods: We carried out a historical prospective follow-up analysis of all patients (age less than 18 years) who underwent pacemaker implantation due to post-surgical heart-block or sinus node dysfunction in the period 1981-2002 at our institution. Data was extracted from the Danish Pacemaker Register and hospital records. Kaplan-Meier survival time estimates and Cox proportional hazards analysis (Relative Risk, RR) were used to identify prognostic factors. Results: High RACHS score (RR, 16.57), low age at implantation (RR, 0.22), low age at operation (RR, 0.06) and epicardial lead (RR, 0.18) were significant predictors for early mortality. Similarly, high RACHS score (RR, 4.84), low age at implantation (RR, 0.32), low age operation (RR, 0.38) and epicardial lead (RR, 0.40) were significant predictors failure of 1st pacemaker system. Conclusions: We identified a number of prognostic factors of patient mortality and failure of systems. One factor, high RACHS score, was previously shown to predict mortality and length of ICU stay in paediatric cardiac surgery; however, this study is the first to show a correlation between RACHS score and mortality as well as failure of pacemaker systems. This may have future implications for preoperative risk stratification of patients and counselling of parents to patients with congenital heart disease.

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“…2 The estimated rate of infection after implantation of permanent endocardial leads is between 1% and 2%, although this rate varies in the literature Clinical Perspective p 1355 from 0.13% to 12.6%. [3][4][5][6][7][8][9][10][11][12][13] The files collected by the National Hospital Discharge Survey revealed that between 1996 and 2003, the rates of hospitalization for infections of implantable antiarrhythmic systems increased faster than the rates of system implantations. 14 To limit the incidence of this major complication, a precise definition and understanding of associated risk factors are needed.…”

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confidence: 99%