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Predictors affecting durability of epicardial pacemaker leads in pediatric patients
Hiroomi Murayama1, Masanobu Maeda, Hajime Sakurai
1Department of Cardiovascular Surgery, Social Insurance Chukyo Hospital, Nagoya, Japan. romiwo@mcn.ne.jp
Insights
Epicardial leads are reliable for pediatric pacing. Structural heart disease is the only significant predictor of lead failure in children and adolescents, impacting long-term durability.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Pacemaker therapy in pediatric patients often uses an epicardial approach.
- Predictors of lead failure in this population require further clarification.
- Understanding lead durability is crucial for long-term patient management.
Purpose of the Study:
- To evaluate the long-term outcomes of epicardial pacing leads in children and adolescents.
- To identify significant predictors of lead failure in pediatric pacing therapy.
Main Methods:
- Retrospective review of 109 pacing leads implanted in 55 pediatric patients.
- Analysis included lead type (fishhook, screw-in, suture-on) and patient characteristics.
- Follow-up duration was a median of 6.4 years.
Main Results:
- Lead failure occurred in 27% of leads, with a median time to failure of 8.4 years.
- Exit block or elevated pacing threshold was the most common failure mode.
- Multivariate analysis identified structural heart disease as the sole significant predictor of lead failure (RR 2.85).
Conclusions:
- Epicardial leads are a dependable method for managing pediatric arrhythmias.
- Structural heart disease is a key factor influencing the longevity of pacing leads in young patients.
- This finding aids in risk stratification and management strategies for pediatric pacemaker recipients.
Objectives:
Despite pacemaker therapy in children and adolescents favoring an initial epicardial approach, predictors of lead failure have not been well clarified. The aim of this study was to assess the long-term outcomes and to determine predictors affecting lead durability in pediatric pacing therapy.
Methods:
We reviewed the outcomes of 109 consecutive pacing leads implanted in 55 patients (median age, 5.2 years; range, 31 days-15.8 years), including 38 atrial and 71 ventricular leads. They consisted of 58 (53%) fishhooks, 37 (34%) screw-in leads, and 14 (13%) steroid-eluting suture-on leads. Seventy (64%) were implanted in patients with structural heart disease.
Results:
The leads were followed for a median of 6.4 years (range, 3 days-22.9 years). Lead failure occurred in 29 leads (27%; median of 8.4 years after implantation). Exit block or elevation of pacing threshold was the most common cause (n = 18), but failures did not directly cause patient death. The overall 1-, 5-, 10-, and 15-year lead survivals were 100%, 89.0%, 72.5%, and 55.5%, respectively. Multivariate Cox analysis revealed concurrent structural heart disease (relative risk, 2.85; 95% confidence interval, 1.27-6.42; P = .011) to be the only significant predictor of lead failure.
Conclusions:
Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease.
