Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Biomedical Engineering

Background:

• Permanent pacing in infants and children is crucial for managing bradyarrhythmias.
• Steroid-eluting leads are designed to reduce pacing threshold rise and improve longevity.
• Comparing epicardial and endocardial lead performance in pediatric patients is essential for optimizing device selection.

Purpose of the Study:

• To compare the performance of steroid-eluting epicardial versus endocardial leads in pediatric patients.
• To evaluate pacing and sensing characteristics, impedances, and lead longevity.
• To assess complication rates associated with each lead type.

Main Methods:

• A retrospective evaluation of 159 steroid-eluting leads implanted in 95 children.
• Patients were categorized into two groups based on weight: Group A (<15 kg) and Group B (>15 kg).
• Pacing thresholds, sensing values, impedances, and complication rates were analyzed for both endocardial and epicardial leads.

Main Results:

• Ventricular endocardial leads demonstrated significantly lower stimulation thresholds at implant and follow-up in both weight groups (p < 0.014 and p < 0.001, respectively).
• Sensing thresholds were also better for ventricular endocardial leads at follow-up in Group B (p < 0.02).
• Complications requiring intervention were observed in both groups, with a higher incidence in the epicardial lead group (n=18) compared to the endocardial group (n=7).

Conclusions:

• Steroid-eluting endocardial leads offer superior pacing thresholds in pediatric patients compared to epicardial leads.
• Despite differences in stimulation thresholds, both endocardial and epicardial steroid-eluting leads exhibit comparable overall performance and longevity in the pediatric population.
• Lead choice should consider patient weight and specific pacing needs, balancing performance with complication risks.