Format

Send to

Choose Destination
Heart Rhythm. 2015 Jan;12(1):111-6. doi: 10.1016/j.hrthm.2014.09.056. Epub 2014 Sep 30.

Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children.

Author information

1
Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California. Electronic address: ceresnak@yahoo.com.
2
Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
3
Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
4
Stanford Center for Clinical & Translational Research & Education, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.

Abstract

BACKGROUND:

Children requiring a permanent epicardial pacemaker (PM) traditionally have a single lead placed on the right ventricle. Lead failure in pacemaker-dependent (PMD) children, however, can result in cardiovascular events (CVEs) and death.

OBJECTIVE:

The purpose of this study was to determine if redundant ventricular lead systems (RVLS) can safeguard against CVE and death in PMD children.

METHODS:

This was a single-center study of PMD patients undergoing placement of RVLS from 2002-2013. Patients ≤21 years of age who were PMD were included. Patients with a biventricular (BiV) system placed for standard resynchronization indications were excluded. RVLS patients were compared to PMD patients with only a single pacing lead on the ventricle (SiV).

RESULTS:

Seven hundred sixty-nine patients underwent PM/implantable cardioverter-defibrillator placement with 76 BiV implants; 49 patients (6%) were PMD. Thirteen patients underwent implantation of an RVLS. There was no difference between the RVLS group (n = 13) and SiV PMD control group (n = 24) with regard to age (RVLS 9.5 ± 5.8 years vs SiV 9.4 ± 6.7 years, P = .52), weight (RVLS 38.2 ± 32.6 kg vs SiV 35.2 ± 29.3 kg, P = .62), indication for pacing, procedural complications, or time to follow-up. There were 2 lead fractures (17%) in the RVLS group (mean follow-up 3.8 ± 2.9 years), with no deaths or presentations with CVE. The SiV control group had 3 lead fractures (13%) (mean follow-up 2.8 ± 2.9 years), with no deaths, but all 3 patients presented with CVE and required emergent PM placement.

CONCLUSION:

RVLS systems should be considered in children who are PMD and require permanent epicardial pacing. BiV pacing and RVLS may decrease the risk of CVE in the event of lead failure in PMD patients.

KEYWORDS:

Biventricular pacing; Children; Pacemaker dependent; Pediatrics; Sudden death

PMID:
25277988
DOI:
10.1016/j.hrthm.2014.09.056
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center