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Actuarial survival of transvenous pacing leads in a pediatric population
Y R Lau1, P C Gillette, D S Buckles
1Medical University of South Carolina, South Carolina Children's Heart Center, Charleston 29425.
Insights
Pediatric pacemaker leads show a 76% survival rate at 5 years. Atrial leads had significantly higher abandonment rates than ventricular leads, indicating a critical factor in lead longevity.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Medical Device Research
Background:
- Endocardial pacing leads are crucial for managing pediatric cardiac conditions.
- Assessing lead longevity is vital for optimizing patient outcomes and healthcare resource allocation.
- Previous data on long-term lead survival in pediatric populations, especially those with congenital heart disease, is limited.
Purpose of the Study:
- To prospectively evaluate the actuarial survival of endocardial pacing leads in a pediatric cohort.
- To identify factors influencing lead abandonment, including lead placement site, cardiac anatomy, and insulating material.
- To provide data for improving lead selection and management strategies in young patients.
Main Methods:
- Prospective follow-up of 148 children and young adults (4 months to 38 years) receiving 213 endocardial pacing leads.
- Actuarial survival analysis to determine lead longevity over time.
- Statistical analysis, including stepwise discriminant analysis, to compare lead abandonment rates based on lead placement (atrial vs. ventricular), cardiac anatomy, and insulating material.
Main Results:
- At 5 years, 76.0% of pacemaker leads remained in use.
- Common reasons for lead abandonment included death, exit block, lead fracture, and adapter malfunction.
- Leads placed in the atrium demonstrated a significantly higher abandonment rate compared to ventricular leads (P < 0.0005).
- Lead insulating material, cardiac anatomy, and indication for pacing did not significantly impact lead survival.
Conclusions:
- Endocardial pacing leads in pediatric patients exhibit a moderate 5-year survival rate.
- Lead placement in the atrium is a significant risk factor for lead abandonment in this population.
- Further research into atrial lead design and implantation techniques may improve long-term lead performance in pediatric patients.
Abstract:
This study was undertaken to examine the actuarial survival of endocardial pacing leads in a pediatric population. We prospectively followed 148 children and young adults age 4 months to 38 years. Of these, 58 had normal cardiac anatomy and 90 had surgically corrected congenital heart disease. A total of 213 leads were inserted in these patients. Actuarial analysis showed that at 5 years 76.0% of the pacemaker leads were still in use. The reasons for abandonment included death (10), exit block (8), lead fracture (8), adapter malfunction (7), and other including infection, lead migration, and pacemaker malfunction (12). Excluding deaths, an actuarial survival curve was constructed. Stepwise discriminant analysis and independent measures of association showed a significant difference in lead abandonment when the leads placed in the atrium were compared to those placed in the ventricle (30 vs 5; P < 0.0005). Lead insulating material, cardiac anatomy, and/or indication for pacemaker placement had no statistically significant impact on lead survival.