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A 12-Year Experience of Bipolar Steroid-Eluting Epicardial Pacing Leads in Children.

Authors :
Tomaske, Maren
Gerritse, Bart
Kretzers, Leo
Pretre, Rene
Dodge-Khatami, Ali
Rahn, Mariette
Bauersfeld, Urs
Source :
Annals of Thoracic Surgery; May2008, Vol. 85 Issue 5, p1704-1711, 8p
Publication Year :
2008

Abstract

Background: Cardiovascular abnormalities and small vascular size may preclude transvenous pacing and necessitate epicardial lead implantation. This study evaluates the performance of steroid-eluting, bipolar epicardial pacing leads. Methods: We prospectively enrolled 114 children with 239 atrial and ventricular bipolar epicardial leads (Medtronic CapSure 10366 or 4968, Minneapolis, MN), followed up to 12.2 years (median, 3.2). Lead data were obtained at implant and at semi-annual visits. Analysis was done for left or right atrial and ventricular leads. Results: Median atrial and ventricular pacing thresholds remained below 1.2 V at 0.5 ms. Thresholds did not differ between pacing sites: left atrial, 0.82V at 0.5 ms; right atrial, 0.74 V at 0.5 ms (p = 0.85); and left ventricular, 0.96V at 0.5 ms; right ventricular, 0.94 V at 0.5 ms (p = 0.65). Sensing demonstrated no difference for atrial leads, at left atrial, 3.4 mV; and right atrial, 2.9 mV (p = 0.12), but there was superiority of left over right ventricular leads (11.2 vs 7.7 mV, p = 0.002). During follow-up, the 239 atrial and ventricular leads experienced 19 (8%) lead failures. Lead survival at 2 and 5 years was 99% and 94% for atrial leads and 96% and 85% for ventricular leads, respectively. Conclusions: Bipolar steroid-eluting epicardial leads demonstrate excellent sensing characteristics and persistent low median pacing thresholds below 1.2 V at 0.5 ms in children during up to 12 years follow-up. Considering growing and active patients with most having congenital heart disease, the lead survival of 85% to 94% at 5 years is favorable. Subanalysis shows superior sensing for left ventricular leads. Bipolar steroid-eluting leads provide an alternative approach for permanent pacing and may also be considered for left atrial and ventricular pacing, resynchronization, or defibrillator therapy. [Copyright &y& Elsevier]

Details

Language :
English
ISSN :
00034975
Volume :
85
Issue :
5
Database :
Supplemental Index
Journal :
Annals of Thoracic Surgery
Publication Type :
Academic Journal
Accession number :
32032381
Full Text :
https://doi.org/10.1016/j.athoracsur.2008.02.016