Upgrade of Single Chamber Pacemakers with Transvenous Leads to Dual Chamber Pacemakers in Pediatric and Young Adult Patients

Abstract

Children with single chamber pacemakers, in adolescence and young adulthood, may be upgraded to dual chamber systems, but there are no published data about indications, timing, and complications. Upgrading was attempted in 18 patients with transvenous pacing leads. A retrospective analysis of all collected data was performed. At initial pacemaker implantation (mean +/- SD, 9.3 +/- 4.1 years), the pacing mode was VVIR (n = 13 patients) and AAI/AAIR (n = 5 patients). After 72 +/- 41 months of follow-up, at the age of 15.5 +/- 5.2 years, upgrade was undertaken because of the patient's age at elective generator replacement (n = 3 patients), ventricular dysfunction (n = 7), syncope/presyncope (n = 3) in patients with VVIR pacing, atrioventricular block (n = 2), and/or drug refractory supraventricular tachyarrhythmias (n = 4) in patients with atrial pacing. In comparison with single chamber pacemaker implantations, the average procedural time and the average fluoroscopy time were not significantly longer. All suitable preexisting leads were incorporated in the new pacing system. Leads were inserted via the ipsilateral subclavian vein in 16 patients. Venous occlusion was found in two patients: in the first the procedure was not performed; in the second, the contralateral vein was used and the old lead was abandoned. There were no procedural complications. During a follow-up of 14 +/- 11 months, ventricular dysfunction worsened in five of seven patients; other patients benefitted symptomatically. In conclusion, pacemaker upgrade is technically challenging but feasible and safe and may be beneficial for some patients.

Outcome of Young Patients with Abandoned, Nonfunctional Endocardial Leads

“…In our experience, indeed, new venous occlusion or tricuspid valve damage was not documented. 5,12,17 However, our finding of venous occlusion might be underestimated as Doppler echo is not as reliable for the evaluation of venous occlusion as with venography or intravascular ultrasound, 10,18,19 as discussed in a recent paper. 17 Furthermore, 5/18 (28%) patients underwent new implantation from the contralateral side, exposing them to the potential risk of bilateral obstruction.…”

“…Patient N. 6 was already included in the group of patients with upgrading of single-chamber to dual-chamber PM. 12 In three patients (N. 6, N. 13, N. 15) subclavian vein occlusion was documented at preoperative (before new lead implant) Doppler-echo examination and confirmed during implantation procedures (Fig. 2).…”

“…The preoperative venous examination, the techniques used for the procedures of PM implantation and PM upgrading, and the follow-up schedule have been described. 1,5,12 In brief, at initial PM implantation, the endocardial leads were inserted by transcutaneous puncture of the subclavian vein and fixed to the subcutaneous tissue with a slowly absorbable ligature in children and adolescent patients. 13 Ventricular leads were positioned in the nonsystemic ventricular apex.…”

“…The first PM implantation was at a median age of 4 (range 0. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] years. In these 18 patients, 19 leads (16 ventricular and three atrial) failed after a median follow-up of 10 (3-15) years, and were abandoned and substituted.…”

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

“…Cases havebeen reported of exit block due to lead fracture caused by the infant's muscular activity. 12 The five-year survival of the conventional epicardial lead is 40-70%. 13,14 In neonates and infants with a permanent pacemakerthe occurrence of episodes of loss of consciousnessmay be due to pacemaker malfunction.…”