Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease
Section snippets
Design and subjects
The study group was identified by retrospective review of medical records and pacemaker databases, and consisted of all patients with pacemakers followed at Children’s Hospital Boston from January 1980 to July 2002. Institutional Review Board approval was obtained prior to data collection. Patients whose initial device and/or lead implants were performed outside the study institution were included as long as subsequent pacing system follow-up was received at the study institution. Older
Patient characteristics
A total of 497 study patients were identified (Table 1). Median age at initial implant was 9.0 years (range 0–54.6 years), and 48% were female. In all, 117 patients (23%) were 18 years or older at initial implant. Median follow-up was 6.2 years (range 0.1–22.0). The majority of patients had structural congenital heart defects (68%), while 21% had primary electrical disease. Of the 339 patients who had undergone prior cardiac surgery, 28% had single ventricle physiology. The most common rhythm
Discussion
The choice of optimal pacemaker lead system requires careful assessment of the risks and benefits of each available option. As in adults, higher pacing thresholds and exit block often complicate epicardial lead use in children.17, 18 The advent of steroid-eluting epicardial leads has partially remedied these problems,10, 19, 20, 21, 22, 23 but epicardial systems require more extensive surgery. Transvenous leads, on the other hand, can result in vascular or valvular damage due to incongruity
Conclusions
In this large, longitudinal study of pacemaker recipients cared for at one pediatric and adult congenital heart disease center, we found a remarkably high incidence of lead failures. Younger children, those with congenital heart defects, and those with epicardial systems experienced lead failure earlier and more often. While the newer epicardial steroid-eluting leads have better longevity than non-steroid-eluting systems, their longevity remains significantly inferior to transvenous leads,
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