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Steroid-eluting epicardial pacing leads in pediatric patients: encouraging early results
J A Johns1, F A Fish, J D Burger
1Division of Pediatric Cardiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Insights
New steroid-eluting epicardial pacing leads show promising results in pediatric patients. These leads offer reliable pacing and sensing for children, especially infants too small for transvenous options.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Pediatric pacing presents unique challenges due to patient size, growth, and congenital heart disease.
- Epicardial pacing, while sometimes necessary, historically has issues with sensing and capture.
- Transvenous endocardial pacing is preferred but not always feasible in pediatric cases.
Purpose of the Study:
- To evaluate the pacing and sensing performance of a novel porous-tipped steroid-eluting epicardial lead.
- To assess the long-term efficacy and safety of this new lead in pediatric patients.
- To determine the suitability of these leads for infants and children requiring epicardial pacing.
Main Methods:
- A cohort of 12 pediatric patients (3 weeks to 18 years) received 23 epicardial leads (8 atrial, 15 ventricular).
- Pacing thresholds, sensing thresholds, and lead impedance were monitored weekly for 6 weeks, then at 3, 6, 12, and 18 months.
- Median follow-up duration was 12 months.
Main Results:
- Atrial pacing thresholds significantly improved over time, while ventricular thresholds remained stable.
- At 6 months, mean pulse width thresholds were 0.10 ± 0.03 ms (atrial) and 0.19 ± 0.09 ms (ventricular) at 2.5 V.
- Excellent sensing capabilities were observed, with all atrial leads sensing at 2.5 mV and ventricular leads at 5 mV at the most recent follow-up.
Conclusions:
- Steroid-eluting epicardial pacing leads demonstrate encouraging early outcomes in pediatric populations.
- The leads exhibit reliable pacing and sensing characteristics, suggesting a viable alternative for pediatric epicardial pacing.
- These leads may be particularly beneficial for infants unsuitable for transvenous pacing, enabling dual-chamber pacing.
Objectives:
This study evaluated the pacing and sensing characteristics of a new porous-tipped steroid-eluting epicardial lead in a group of pediatric patients.
Background:
Pacing in children may be complicated by small patient size, patient growth and the prevalence of structural congenital heart disease in children requiring pacing. Epicardial pacing has been associated with a high incidence of problems with sensing and capture, prompting the use of transvenous endocardial pacing when possible. In some children, epicardial pacing may still be desirable because of small patient size, potential for caval obstruction, previous cardiac surgery limiting transvenous access to the heart, or the need to repair congenital heart disease at the time of pacemaker insertion.
Methods:
Twelve patients aged 3 weeks to 18 years underwent placement of 23 epicardial pacing leads (8 atrial, 15 ventricular). Pulse width thresholds, sensing thresholds and lead impedance were measured weekly for 6 weeks, then at 3, 6, 12 and 18 months after pacemaker implantation. The median duration of follow-up was 12 months.
Results:
Ventricular pulse width thresholds did not change over time, whereas atrial pulse width thresholds improved significantly. At 6 months, the mean pulse width threshold at 2.5 V for the atrial and ventricular leads was 0.10 +/- 0.03 and 0.19 +/- 0.09 ms, respectively. The thresholds were slightly lower at 12 and 18 months. At the most recent follow-up, all atrial leads sensed appropriately at 2.5 mV and all ventricular leads at 5 mV.
Conclusions:
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.