Steroid-eluting epicardial pacing leads in pediatric patients: Encouraging early results

Abstract

These encouraging early results suggest that steroid-eluting epicardial pacing leads may be an attractive option for children needing epicardial pacing. Their excellent pacing and sensing characteristics may allow reliable dual-chamber pacing in infants who are too small for transvenous pacing.

Permanent Epicardial Pacing in Pediatric Patients

“…The only significant drop in ET occurred 1 month after implantation in the steroid-eluting leads. This is similar to the study of Johns et al, 12 who reported a significant decrease in atrial pulse width threshold 1 week after implantation, with little change thereafter. In contrast to the atrial leads, the nonsteroid ventricular stimulation thresholds were significantly worse than the steroid-eluting leads at acute and 2-year follow-up.…”

“…5,8 Recent advances in epicardial leads and surgical approaches have demonstrated improved early pacing and sensing thresholds. 12,13,18,19 Prior studies evaluating epicardial leads in children have had low patient numbers or have involved series that predated both the introduction of lithium iodide batteries and steroid-eluting leads. 8,12,20,21 In the present study, we report our long-term experience with Ͼ200 epicardial pacing leads in children during a 17-year enrollment.…”

“…10,11 Recent advances in lead technology and surgical approach, such as steroid epicardial leads and left atrial leads, have demonstrated encouraging early sensing and pacing qualities when used in children. 12,13 The use of these new implant strategies on long-term lead survival have not been well established. The objective of the present study was to report our long-term experience with a large number of epicardial pacemakers and to identify possible predictors of early and late lead-related complications.…”

Surgical Placement of Permanent Pacemaker Following Temporary Trasvenous Pacemaker in a Child with Congenital Heart Block and Moderate Size PDA: A Case Report

“…9 The usual epicardial leads are associated with a high incidence of rapidly increasing sensing and pacing thresholds after lead placement, necessitating the early replacement of lead and generator. Endocardial leads are favoured inolder infants with a body weight >8 kg, 10 or preferably15-20 kg, 11 . Moreover, insmall infants the small dimensions of the atrium 11 areinsufficient for successful placement of the preformedatrial lead.The elevated pacing thresholds and the high incidenceof exit block associated with conventional epicardialleads are caused by a combination of epicardial fibrosiswith scar formation, and/or pericardial adhesionsfollowing the surgical procedure.…”

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

“…The introduction of modern steroid-eluting bipolar leads has resulted in improved lead performance and survival of both epicardial and endocardial leads (Goldman-Cutler et al, 1997;Johns et al, 1992; Udink ten . The addition of steroid elution limits the inflammatory response at the electrode-tissue interface, resulting in better acute and chronic stimulation thresholds and improved battery longevity (Mond & Stokes, 1992).…”