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A comparison of steroid-eluting epicardial versus transvenous pacing leads in children
A Dodge-Khatami1, C L Johnsrude, C L Backer
1Department of Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA.
Insights
Steroid-eluting epicardial (EPI) pacing leads show performance equivalent to transvenous (TV) leads in children. EPI leads are recommended for long-term pacing when feasible.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Congenital heart disease often necessitates long-term pacing in children.
- Steroid-eluting (SE) pacing leads aim to improve lead performance and longevity.
- Epicardial (EPI) and transvenous (TV) lead implantation techniques have distinct characteristics.
Purpose of the Study:
- To compare the acute and chronic performance of SE epicardial (EPI) pacing leads versus SE transvenous (TV) pacing leads in pediatric patients.
- To assess sensing thresholds, capture thresholds, and impedance for both lead types.
Main Methods:
- A retrospective analysis of 55 children with congenital heart disease who received 85 SE pacing leads (38 EPI, 47 TV) between 1989 and 1997.
- Evaluation of acute and chronic sensing and capture thresholds, and impedance for all implanted leads.
- Comparison of patient demographics, including age at implantation and follow-up duration.
Main Results:
- Acute and chronic sensing and capture thresholds were comparable between SE EPI and SE TV leads.
- Steroid-eluting transvenous (TV) leads demonstrated consistently higher chronic impedance compared to steroid-eluting epicardial (EPI) leads.
- Patients receiving EPI leads were younger at implantation and had shorter follow-up periods.
Conclusions:
- Steroid-eluting epicardial (EPI) pacing leads are functionally equivalent to steroid-eluting transvenous (TV) leads at intermediate follow-up.
- The study recommends considering SE EPI leads before resorting to the TV approach for children requiring lifelong pacing.
- This finding supports the use of EPI leads as a viable option in pediatric cardiac pacing.
Objective:
To evaluate the acute and chronic performance of steroid-eluting (SE) epicardial (EPI) pacing leads as compared to SE transvenous (TV) pacing leads in children.
Methods:
From 1989 through 1997, 55 children with congenital heart disease received a total of 85 SE pacing leads, of which 38 were EPI and 47 TV. The mean age of children receiving EPI leads was younger than those receiving TV leads (7.7 months vs 15.1 years, p = 0.001), and they had shorter follow-up (17.2 months vs 36.2 months, p < 0.001). All leads were evaluated for acute and chronic sensing and capture thresholds, and impedance.
Results:
Acute and in particular chronic atrial and ventricular sensing and capture thresholds in SE EPI and TV leads were essentially equivalent. [table: see text]. The chronic impedance of TV leads (atrial 525 ohms, ventricular 520 ohms) was consistently higher than EPI leads (atrial 404 ohms, ventricular 386 ohms).
Conclusion:
At intermediate follow-up, SE EPI leads are functionally equivalent to SE TV leads. We recommend the use of SE EPI leads as long as practically feasible prior to using the TV approach in children who will require a life-time of pacing.
