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Cardiac pacing problems in infants and children: results of a 4-year prospective study

J Villafañe1, E Austin

  • 1Department of Pediatrics, University of Louisville School of Medicine, Ky 40292.

Southern Medical Journal
|July 1, 1993
PubMed

Insights

A 2.5 V amplitude setting is unsafe for pediatric patients with non-steroid epicardial ventricular leads within 20 weeks post-implantation due to exit block. Steroid-tip leads are recommended to prevent pacing issues.

Area of Science:

  • Pediatric Cardiology
  • Biomedical Engineering
  • Electrophysiology

Background:

  • Cardiac pacing is crucial for pediatric patients with heart rhythm disorders.
  • Evaluating pacing parameters like amplitude is essential for safety and efficacy.
  • Exit block (EB) is a potential complication affecting pacing function.

Purpose of the Study:

  • To assess the safety and effectiveness of a 2.5 V amplitude setting in pediatric cardiac pacing.
  • To identify factors influencing pacing thresholds and exit block in pediatric patients.

Main Methods:

  • Prospective study of 29 pediatric patients with a mean follow-up of 16.4 months.
  • Analysis of pacing thresholds and exit block at a 2.5 V amplitude setting.
  • Comparison of lead types (epicardial vs. endocardial, steroid-tip vs. non-steroid-tip) and lead positions (ventricular vs. atrial).

Main Results:

  • Exit block (EB) at 2.5 V occurred in 26% of leads, with no new cases after 20 weeks.
  • Ventricular leads (39%) and epicardial leads (47%) showed higher EB rates than atrial (8%) and endocardial (4%) leads, respectively.
  • Steroid-tip leads demonstrated no exit block and lower mean pulse width thresholds (PWT) for endocardial ventricular leads.

Conclusions:

  • A 2.5 V amplitude is not safe for non-steroid epicardial ventricular leads in children within 20 weeks post-implantation.
  • Recommended pacing approach includes 5.0 V amplitude for epicardial leads initially and prioritizing endocardial steroid-tip leads.
  • Steroid-tip technology significantly reduces the risk of exit block in pediatric cardiac pacing.

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