Evaluation of different lead types and implantation techniques in pediatric populations with permanent pacemakers: Single-center with 10 years' experience
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Yakup Ergul1, Bekir Yukcu1, Erkut Ozturk1
1Department of Pediatric Cardiology/Electrophysiology, Istanbul Mehmet Akif Ersoy Cardiovascular Research and Training Hospital, Saglik Bilimleri University, Istanbul, Turkey.
Insights
Permanent pacemaker lead failure is a concern in children. This study found that while lead survival rates varied by type, all showed satisfactory early to midterm performance, with transvenous pacing leads demonstrating the best long-term survival.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Cardiac Electrophysiology
Background:
- Permanent pacemaker (PM) implantation in children presents challenges, particularly concerning lead performance during follow-up.
- Lead failure is a significant issue in pediatric PM systems, necessitating evaluation of different implantation techniques and lead types.
Purpose of the Study:
- To assess the impact of various lead types and implantation techniques on the early and midterm performance of permanent pacemaker systems in pediatric patients.
- To compare lead electrical performance, failure rates, and survival outcomes across different lead categories.
Main Methods:
- Retrospective analysis of 323 permanent pacemaker lead implantations in 167 pediatric patients over a 10-year period.
- Patients were categorized into epicardial pacing (EP), transvenous pacing (TP), and Select Secure (SS) lead groups.
- Evaluation included demographic data, pacing indications, lead electrical parameters, lead failures, complications, and survival rates.
Main Results:
- No significant differences were observed in initial or follow-up lead electrical performance (capture, threshold, sensing, impedance) between lead groups.
- Twenty lead failures occurred during a median follow-up of 3.3 years, with no statistically significant difference in failure rates among EP, TP, and SS leads.
- Five-year lead survival was 98% for TP, 95% for EP, and 90% for SS; 10-year survival was 90% for TP, 70% for EP, and 70% for SS.
Conclusions:
- Despite technological advancements, pacemaker lead failure remains a critical concern in pediatric patients.
- Early to midterm lead survival rates for epicardial, transvenous, and Select Secure leads were satisfactory.
- Transvenous pacing leads exhibited superior long-term survival rates compared to epicardial and Select Secure leads in this pediatric cohort.
Background:
Permanent pacemaker (PM) implantation is performed for various indications and by different techniques in children; however, many problems with lead performance are encountered during follow-up. This study aims to evaluate the possible effects of different lead types and implantation techniques on pacing at early and midterm in children with a permanent PM.
Patients And Methods:
Pediatric patients who underwent permanent PM system implantation at our tertiary cardiac surgery center between January 1, 2010 and January 1, 2020 were evaluated retrospectively. Patients were categorized in the epicardial pacing lead (EP), transvenous pacing lead (TP), and transvenous bipolar lumenless (Select Secure [SS]) lead groups according to the lead implantation technique and lead type with the same manufacturer. Groups were evaluated statistically for demographic features, pacing type and indication for implantation, lead electrical performance, lead failure, complications, and outcome.
Results:
Over 10 years, 323 lead implantations were performed on 167 patients (96 males, median age 68 months [5 days-18 years]). Of 323 leads, 213 (66%) were EP, 64 (20%) were TP, and 46 (14%) were SS. Of the total, 136 of the leads were implanted in atria, and 187 were implanted in ventricles. Primary pacing indications were postoperative complete atrioventricular (AV) block (n = 95), congenital AV block (n = 71), sinus node dysfunction (n = 13), and acquired complete AV block (n = 1). Additional cardiac diseases were present in 115 patients (69%). No statistically significant difference was observed in gender, syndrome, or pacing indication (P > .05). Atrial and ventricular capture, threshold, sensing, and lead impedance measurements were not significantly different at the initial and follow-up periods (P > .05). The median follow-up duration was 3.3 years (6 months-10 years). Twenty lead failures were determined in 15 patients (EP: 14 lead failures in 10 patients; TP: two lead failures in two patients; and SS: four lead failures in three patients) during follow-up, and no statistically significant difference was found between groups (P = .466). The 5-year lead survival was 98% for TP, 95% for EP, and 90% for SS; the 10-year lead survival was 90% for TP, 70% for EP, and 70% for SS. There was no mortality related to chronic pacing or due to the procedure of implantation.
Conclusions:
Despite improvements in technology, lead failure is still one of the most critical problems during these patients' follow-up. Early to midterm lead survival rates of all three lead types were satisfactory.
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