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Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart
Elizabeth B Fortescue1, Charles I Berul, Frank Cecchin
1Arrhythmia Service, Department of Cardiology, Children's Hospital Boston and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Pediatric pacemaker lead failures are common, particularly in young children with congenital heart defects and those with epicardial leads. Individualized care and considering transvenous systems can improve outcomes.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Medical Device Research
Background:
- Pediatric pacemaker management is complex due to small patient size, congenital heart disease, and growth.
- Identifying risk factors for pacemaker lead failure is crucial for improving outcomes in children.
Purpose of the Study:
- To analyze pediatric pacemaker lead failure outcomes over a 22-year period.
- To identify specific risk factors associated with lead failure in pediatric patients.
Main Methods:
- Retrospective analysis of 1007 leads implanted in 497 pediatric patients (1980-2002).
- Lead failures defined as repair, replacement, or abandonment due to mechanical or electrical issues.
- Logistic regression and Cox analyses used to identify risk factors for lead failure.
Main Results:
- 15% of leads (155) and 23% of patients (115) experienced lead failure.
- Independent risk factors for lead failure included age <12 years, congenital heart defects, and epicardial lead placement.
- Younger patients (<12) had more fractures; congenital heart defect patients had more exit block; epicardial leads had higher fracture/exit block rates.
Conclusions:
- Pediatric pacing patients exhibit a high incidence of lead failures.
- Lead failures are most prevalent in younger patients, those with congenital heart disease, and epicardial systems.
- Individualized pacing strategies and increased use of transvenous systems (when feasible) are recommended to mitigate lead failure risks.
Objectives:
To examine outcomes of children with pacemakers over a 22-year period and identify risk factors for lead failure.
Background:
Small patient size, structural cardiac abnormalities, and growth may complicate pediatric pacemaker management. Better knowledge of risk factors for lead failure in these patients may help improve future outcomes.
Methods:
All pacemaker patients followed at one pediatric center 1980-2002 were included. Lead failures were identified retrospectively as leads repaired, replaced, or abandoned due to fracture, insulation break, dislodgement, or abnormalities in pacing or sensing. Risk factors were identified using logistic regression and Cox analyses.
Results:
A total of 1007 leads were implanted in 497 patients during the study period (5175 lead-years). Median age at implant was 9 years (0-55); 64% of patients had structural congenital heart disease. Median follow-up time was 6.2 years (0-22). Lead failure occurred in 155 leads (15%), and 115 patients (23%), with 28% of patients experiencing multiple failures. Significant independent correlates of lead failure included age <12 years at implant, history of structural congenital heart defects, and epicardial lead placement. Younger patients (<12 years) experienced significantly more lead fractures than older children (P = .005), while patients with congenital heart defects experienced more exit block. Epicardial leads were more likely to fail due to fracture or exit block, while transvenous leads failed more due to insulation breaks or dislodgements.
Conclusions:
Pediatric pacing patients have a high incidence lead failures. These occur most commonly in younger patients, structural congenital heart disease, and those with epicardial lead systems. Approaches to pacing system implantation and follow-up in these patients need to be individualized, with special attention to minimizing risk of lead failures. Our findings suggest that expanded utilization of transvenous systems in smaller patients seems justified when anatomy permits.
