Active fixation of endocardial pacing leads: the preferred method of pediatric pacing

Pacing system failure due to lead related problems may necessitate repositioning or explantation of the problem lead. Pediatric patients with permanent pacemakers have additional considerations that necessitate revision or explantation of pacing leads. Active fixation type leads appear to offer the physician advantages over passive fixation leads that may make them the lead of choice for use in children. We reviewed our experience with active fixation type leads to determine whether the ease with which these leads could be revised or explanted justified recommending their use in our patients. Eleven patients underwent 13 lead revisions. The time from implant to revision was a mean of 12.3 months. Six patients had previously undergone repair of a congenital heart defect. Modes of pacing were: DDD (seven); AAI (three); and VVI (one). Exposed, isodiametric leads accounted for 11/13 leads. Leads were successfully explanted in nine cases and repositioned in four cases. The only lead that could not be revised and resulted in retention was a nonisodiametric, retractable helix lead at the junction of the subclavian vein and clavicle. We conclude isodiametric active fixation leads can be safely repositioned or explanted in children and should be considered the preferred method for endocardial pacing in children.