Risk Factors for Venous Obstruction in Children with Transvenous Pacing Leads

Abstract

To determine the incidence and risk factors for venous obstruction in children with transvenous pacing leads, 63 children were evaluated clinically and echocardiographically. Patients with abnormal clinical and/or echocardiographic findings were further investigated by venography. Thirteen patients (21%) had evidence of venous obstruction. Venography in 11 (2 refused) showed that severity of obstruction (as defined by percentage of luminal narrowing) was complete (100%) in 3, severe (> 90%) in 4, and moderate (60%-90%) in 5 (1 patient having 2 sites of obstruction). Risk factors for obstruction in 55 patients with single implantation procedures (10 with obstruction; 18%) were sought. Total cross-sectional area of lead(s) was indexed to body surface area at implantation (INDEX). Patients with obstruction had a higher mean INDEX (7.6 +/- 1.6 mm2/m2) than patients without obstruction (4.9 +/- 2.0 mm2/m2); P < 0.0002). Receiver-operator characteristic curves showed an INDEX > 6.6 mm2/m2 to best predict obstruction, with a sensitivity of 90% and specificity of 84%. Since pacing is lifelong, sizing of transvenous leads to the child is important to prevent obstruction and preserve venous access.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…Data are inconclusive for showing that anticoagulation prevents thrombosis in these patients. Figa et al 536 reviewed risk factors for venous obstruction in pediatric patients with transvenous leads. A cross-sectional pacemaker lead area of >6.6 mm 2 /m 2 body surface area increases the risk for thrombosis.…”

Transvenous pacing after the Mustard procedure: considering the complications

“…10 Figa et al showed in children that the main risk factor for obstruction was found to be related to the total cross-sectional area of the lead as compared with the body surface area at implantation. 11 A ratio >6.6 mm 2 /m 2 was found to best predict venous obstruction. When selecting the pacemaker the leads, the use of an active-fixation lead seems preferable to a passive-fixation lead, given the abnormal positioning of the atrial lead in a systemic venous baffle and the placement in the nontrabeculated morphological left ventricle.…”

Pacing Therapy in Infants and Children with Congenital and Acquired Complete Atrioventricular Block: Optimal Pacing Strategies, Management, and Follow-up

“…A recent study showed that patient age, body size, and lead characteristics at implant did not clearly predict venous occlusion (Bar-Cohen et al, 2006). However, an earlier study concluded that if the lead size indexed to body surface area was more than 6.6 mm2/m2, venous thrombosis could be predicted with a sensitivity of 90% and specificity of 84% (Figa et al, 1997). The recent development of a lumenless 4.1 F endocardial lead is a promising new lead design, which may decrease the risk for venous occlusion in children (Chakrabarti et al, 2009).…”

“…The concern of venous patency in children who need life-long pacing has been an argument for a more conservative approach of selecting a lead system, preferring the epicardial approach (Bracke et al, 2003;Bar-Cohen et al, 2006). Complete venous obstruction has been documented in 11 -21% of children at medium-term follow-up (Bar- Cohen et al, 2006;Figa et al 1997, Kammeraad et al, 2004. Partial venous obstruction may be seen in another 12% of children receiving an endocardial pacing system Fig.…”