Pacemaker lead prolapse through the pulmonary valve in children

Area of Science:

• Pediatric Cardiology
• Cardiac Electrophysiology
• Interventional Cardiology

Background:

• Transvenous pacemaker leads in children often have extra length for growth.
• Excess lead slack can lead to prolapse into the pulmonary artery, potentially impairing valve function.

Purpose of the Study:

• To evaluate the effectiveness of lead repositioning in pediatric patients with pulmonary valve insufficiency due to lead prolapse.

Main Methods:

• Retrospective review of pediatric patients with pacemaker lead prolapse.
• Analysis of demographics, lead type, implant duration, radiography, and echocardiography.
• Assessment of lead repositioning or extraction procedures.

Main Results:

• Nine of eleven pediatric patients underwent lead repositioning for prolapse.
• Pulmonary regurgitation showed mild improvement post-revision, but tricuspid regurgitation had limited change.
• Longer implanted leads showed less improvement; two patients developed pulmonary stenosis.

Conclusions:

• Pacemaker lead prolapse in children is associated with excess lead length for growth.
• Lead repositioning is feasible but may require extraction for chronic or adherent leads.
• Lead revision does not guarantee resolution of pulmonary insufficiency, potentially causing permanent valve damage.