Epicardial Lead Performance Trends in Pediatric and Congenital Heart Disease

Area of Science:

• Cardiology
• Pediatric Electrophysiology
• Biomedical Engineering

Background:

• Epicardial pacing systems are preferred for pediatric patients unsuitable for transvenous leads due to size or complex congenital heart disease (CHD).
• Existing studies suggest higher failure rates for epicardial leads compared to transvenous leads, with limited data on acute performance.
• Assessing acute post-implant and one-year lead performance is crucial for understanding epicardial pacing reliability.

Purpose of the Study:

• To evaluate the acute performance of epicardial pacing leads in the immediate post-implantation period.
• To assess the one-year follow-up performance of these leads.
• To identify factors influencing lead threshold changes in the acute phase.

Main Methods:

• Retrospective single-center study of pediatric and adult patients with CHD receiving epicardial pacing leads and generators (January 2012 - June 2022).
• Analysis of lead performance, focusing on threshold measurements (using a critical threshold of 2V).
• Evaluation of lead impedance, presence of CHD, perioperative status, and lead location (atrial vs. ventricular).

Main Results:

• 256 leads were implanted in 127 patients; 79% were in patients with CHD.
• 18% of leads (47/256) had an implant threshold ≥2V; 89% of these improved to <2V by postoperative day 1 (POD1).
• Factors like impedance, CHD, perioperative status, and lead location did not significantly impact the odds of a persistently high threshold on POD1.

Conclusions:

• Epicardial pacing lead thresholds generally demonstrate improvement in the immediate postoperative period.
• The majority of leads with initially high thresholds achieve acceptable levels (<2V) by POD1.
• This suggests favorable acute performance of epicardial pacing leads in this patient population.