Permanent Epicardial Pacing in Pediatric Patients: 12-Year Experience at a Single Center

Kwak, Jae Gun; Kim, Soo Jin; Song, June O.; Choi, Eun Young; Lee, Sang Yoon; Shim, Woo Sup; Lee, Chang Ha; Park, Chun Soo

doi:10.1016/j.athoracsur.2011.09.072

Cited by 30 publications

(23 citation statements)

References 25 publications

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“…These findings demonstrate that overall epicardial lead survival is significantly better than that reported in previous studies in the pediatric population. 2,6,11,12,[16][17][18][19] In mixed pediatric cohorts consisting of patients with and without CHD, the short-term (2-2.5 years) and midterm (5-6 years) incidence of epicardial lead malfunction has previously been reported to be 10%-34% and 26%-40%, respectively, with a paucity of long-term data. 12,17,20,21 Murayama et al 20 identified the presence of CHD as predictive of subsequent lead malfunction, imparting a 2.9-fold increase in risk compared with those implanted in patients without CHD.…”

Section: Discussionmentioning

confidence: 99%

Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

et al. 2015

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“…steroid-eluting bipolar epicardial pacemaker leads show good long term performance and durability [12,13]. The currently available data concerning advantages and disadvantages of endocardial versus epicardial pacemaker leads remain contradicting.…”

Section: Discussionmentioning

confidence: 99%

Performance of steroid eluting bipolar epicardial leads in pediatric and congenital heart disease patients: 15 years of single center experience

Paech

Kostelka

Dähnert

et al. 2014

J Cardiothorac Surg

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ObjectiveCardiac pacing is sometimes required for patients with congenital heart disease for various reasons. Because of complex anatomy, repetitive previous heart surgery and patient size, epicardial leads are of special importance in these patients. Using epicardial leads has been discussed controversly regarding pacing performance and lead survival. The aim of this study was to review the long-term data on pacing performance as well as lead survival of epicardial leads implanted in our center.MethodsRetrospective chart review and review of the literature.Results82 consecutive pediatric patients or adult patients with congenital heart disease with 158 epicardial leads (Medtronic 4968, bipolar, steroid - eluting) were included. We found 1.2% pacemaker-related early postoperative complications. The incidence of lead dysfunction was 7.5% (12/158) for primary (i.e. directly related to the lead itself) lead dysfunction and 3.2% (5/158) of lead abandonment for reasons not directly related to the lead itself. Primary lead dysfunction occured after a median of 3.83 years. Lead survival at 2, 5 and 10 years was 98.7%, 93% and 92.4%. There were no infections reported. Stable median measurements for impedance (RA/RV/LV of 577/483/610 Ohm), sensing threshold (RA/RV/LV of 2.0/11.0/10.0 mV) and pacing threshold (RA/RV/LV of 0.75 V at 0.4 ms/1.0 V at 0.49 ms/1.0 V at 0.45 ms) indicated a good mid- to longterm performance. The only risk factor for primary lead dysfunction was young age at implantation.ConclusionThe use of epicardial leads in pediatric and adult patients with congenital heart disease shows good longterm outcomes in terms of pacing performance and lead survival. The authors encourage using epicardial leads in patients with congenital heart disease based on the patient‘s individual characteristics.

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“…8 There are some concerns about the long-term durability of epicardial leads. 17 The atrial transseptal approach to LV endocardial pacing was initially described by Jaïs et al 10 Modifications of the technique have been developed for the past decade, but it remains complex, with a combined inferior and superior approach used to puncture the atrial septum and deliver a lead from the subclavian vein. [9][10][11][12][13] Balloon dilatation of the septum and the use of snares to feed guidewires or pacing leads across into the left atrium is a common feature.…”

Section: Discussionmentioning

confidence: 99%

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

Betts

Gamble

Khiani

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Left ventricular (LV) pacing through the coronary sinus is the standard approach for cardiac resynchronization therapy. When this route is unavailable, the alternatives have major limitations. LV endocardial pacing through the interventriuclar septum may offer a simpler solution. We describe an initial case series to demonstrate technical feasibility and to describe our refinement of the puncture technique. Methods and Results-Ten patients with previous failed coronary sinus lead implant or with nonresponse to cardiac resynchronization therapy and a suboptimal LV lead position were selected. All patients were anticoagulated. Left ventriculography and coronary angiography were performed to identify LV borders and septal vessels. Subclavian vein access was used for a superior approach ventricular transseptal puncture under fluoroscopic guidance, using a steerable sheath and a standard transseptal needle, radiofrequency needle, or radiofrequency energy delivered through a guidewire. An active-fixation pacing lead was successfully delivered to the endocardial wall of the lateral LV in all patients (9 men; age, 62±10 years). LV lead implant procedure time shortened with experience. The use of radiofrequency energy delivered through a guidewire was the most effective technique. Mean threshold and R wave at implant were 0.8±0.3 V and 10.8±3.9 mV. At follow-up (mean, 8.7 months; minimum, 0; and maximum 19), thresholds were stable, and there were no thromboembolic events. Of 9 patients, 8 were classed as clinical responders (1 had inadequate follow-up to assess response). Conclusions-LV endocardial pacing through a ventricular septal puncture is a feasible approach for cardiac resynchronization therapy. (Circ Arrhythm Electrophysiol. 2014;7:17-22.)Key Words: cardiac resynchronization therapy ◼ endocardium ◼ heart ventricles ◼ septal Received September 11, 2013; accepted December 16, 2013. From the Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom (T.R.B., J.H.P.G., R.K., Y.B., K.R.); and Department of Cardiology, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, United Kingdom (R.K. Figure 1). Once a LV pressure trace was seen, a hand injection of contrast media was used to confirm that the needle was in the LV cavity. The dilator and sheath were then advanced 10 to 20 mm into the chamber over the needle. The needle was withdrawn and a 0.032-inch stiff 260-cm J guidewire was advanced through the sheath and dilator and curled in the LV cavity. The sheath and dilator were then advanced through the septum until the sheath tip was 1 to 2 cm inside the LV. The sheath and dilator were withdrawn and exchanged over the stiff guidewire for a slit-able, deflectable lead delivery catheter and dilator (Medtronic Attain or Select Secure; Medtronic, Minneapolis, MN). 2. Radiofrequency needle (cases 2 and 3): the procedure was performed using a stiff 98-cm radiofrequency transseptal needle (NRG; Bayliss Medical, Montreal, Canada). When opposed against the s...

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Permanent Epicardial Pacing in Pediatric Patients: 12-Year Experience at a Single Center

Cited by 30 publications

References 25 publications

Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

Performance of steroid eluting bipolar epicardial leads in pediatric and congenital heart disease patients: 15 years of single center experience

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

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