Predictors affecting durability of epicardial pacemaker leads in pediatric patients

Abstract

Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease.

Failure of epicardial pacing leads in congenital heart disease: not uncommon and difficult to predict

“…However, in the presence of (relative) contraindications for the transvenous approach, such as small body size, an intra-cardiac shunt or absence of a venous access, an epicardial lead implantation is preferred despite the high rate of lead failure. The estimations of lead longevity vary widely, and seems to be difficult to predict whereas different risk factors for lead failure had been described [3][4][5][6][7][8][9][10]. In our study, we found an incidence of lead failure of 2.3% per lead per year of follow-up.…”

“…Fortescue et al found that a lower age (< 12 years) at first implant and the presence of structural congenital heart disease were both independent predictors for reduced lead longevity with an HR of 2.7 (p<0.001) and 1.8 (p=0.007), respectively [11]. The presence of structural congenital heart disease as an independent predictor for lead failure was confirmed by Murayama et al The patient's age at implantation was not a predictor for lead failure in their study [6]. In our study we could not find an association between the presence of a structural heart disease and the occurrence of lead failure.…”

“…Murayama et al found an incidence of lead failure of 3.4% per lead per year of follow-up. With an overall 10-years freedom of lead failure of 72.5% [6]. Recently, Tomaske et al described their experience in the use of epicardial pacing leads in 114 children with a median age of 6.2 years [8].…”

Long-Term Follow-Up Shows Excellent Transmural Atrial Lead Performance in Patients With Complex Congenital Heart Disease

“…9,10 Epicardial lead sites can be also be problematic because patients frequently have extensive epicardial scarring because of multiple re-entry sternotomies and may have surgical patches or extensive atrial suture lines limiting availability of an appropriate epicardial site for lead implantation. [2][3][4][5][6][7][8] Transmural placement of atrial pacing leads has been previously described [11][12][13][14] and has been performed on selected patients at our institution since 1998. The present analysis of chronic TMA lead performance validates the use of this approach as a practical and appropriate treatment option.…”

“…This study does not account for multiple potential confounding variables that may affect lead performance although these would largely tend to have a negative effect on lead performance, which was not observed in this study. 2,5,15 Finally, it is conceivable that placement of the TMA lead, while relatively focal, could contribute to postoperative IART, as might be the case for any surgical scar/barrier.…”