Permanent Epicardial Pacing in Pediatric Patients

Abstract

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.

Ventricular Pacing via the Coronary Sinus in a Patient with a Mechanical Tricuspid Valve Prosthesis

“…Also long-term epicardial pacing thresholds are inferior to transvenous pacing thresholds and epicardial lead failure rate is high À26% for epicardial leads overall. 1) In recent years, technological improvements and the development of leads specifically designed for left ventricular pacing have made left have since confirmed the medium to long-term success rate. 4) This method has also been used successfully in patients with complex congenital heart disease with no venous access to the right ventricle.…”

Avaliação da estimulação ventricular direita crônica em crianças e adultos jovens com bloqueio atrioventricular congênito isolado

“…Esta simplificação tem como objetivo diminuir o número de cabos-eletrodos e facilitar tanto o implante inicial quanto as futuras intervenções para manutenção do sistema de estimulação. Por outro lado, em adolescentes, à semelhança do que se faz em adultos, os marca-passos AV transvenosos são os mais utilizados 24,106,108 .…”

“…As crianças que se apresentam com bloqueio AV total e função ventricular normal podem, inicialmente, receber um marcapasso unicameral ventricular e, posteriormente, serem submetidos a um upgrade para o modo atrioventricular na adolescência [22][23][24] . Alternativamente, pode-se optar pelo implante de marca-passo dupla câmara já no primeiro implante.…”

“…A taxa de sobrevida média de cinco anos para cabos-eletrodos endocárdicos em crianças variou entre 76% e 89%, enquanto reoperações ou complicações devido a cabos-eletrodos epicárdicos foram observadas em 15% a 20% dos pacientes 12,19,20,[22][23][24]31 . …”

“…Da mesma forma, neonatos, lactentes e pré-escolares têm recebido, preferencialmente, marca-passos ventriculares, ficando a estimulação AV reservada para os adolescentes ou para os escolares que já tenham um maior desenvolvimento físico [22][23][24] . Ressincronizadores são raramente utilizados no primeiro implante 25 .…”