Actively Adhering Endocardial Leads for Pacing in Children

Abstract

Cardiac pacing in children still presents problems concerning the most favorable placement of the generator and, in particular, the growth-induced electrode complications. Whereas in infants epicardial implantation is unavoidable, one would prefer transvenous placement in older children to permit replacement or removal without extensive operative measures. The use of actively anchorable endocardial leads seems advantageous because of the possibility of placing long electrode loops in the cavity of the right atrium without increasing the risk of dislodgement. In this way overextension of the lead during growth may be avoided. Since June 1975 we have performed ventricular pacing in 10 children, aged 2 to 9 years, by using a transvenous screw-in electrode (surface 6 mm2). Acute threshold values ranged from 0.4 to 0.7 mA ap a pulse duration of 1.0 msec and sensitivity between 6.5 and 8.7 mV. Electrode function has been without complications up to now. In 6 patients we implanted programmable pacemaker systems which allowed postoperative threshold measurements. The chronic threshold value has not increased above 2.3 mA in any of these cases. In our opinion, actively anchorable endocardial leads present significant advantages for pacing in childhood.

Implantable Cardioverter Defibrillator Lead Complications and Laser Extraction in Children and Young Adults with Congenital Heart Disease: Implications for Implantation and Management

“…These longitudinal forces can stretch open the high‐voltage shocking coils and ultimately result in wire fracture, both of which can be detected radiographically. The creation of a long redundant loop of lead in the atrium or inferior vena cava at implantation has been proposed as a method to reduce the incidence of growth‐related lead damage by allowing lead “release” over time 16,17 . This technique, although often effective with pacemaker leads, fails when scar tissue forms at multiple sites along the lead, including in the redundant loop itself 18 .…”