Surgical Approaches to Epicardial Pacemaker Placement: Does Pocket Location Affect Lead Survival?

Overview

Journal Pediatr Cardiol

Specialties Cardiology & Vascular Diseases
Pediatrics

Date 2010 Aug 7

PMID 20690018

Citations 6

Authors

Brian J Lichtenstein

David P Bichell

Dana M Connolly

John J Lamberti

Suzanne M Shepard

Stephen P Seslar

Affiliations

Soon will be listed here.

Abstract

Permanent cardiac pacing in pediatric patients presents challenges related to small patient size, complex anatomy, electrophysiologic abnormalities, and limited access to cardiac chambers. Epicardial pacing currently remains the conventional technique for infants and patients with complex congenital heart disease. Pacemaker lead failure is the major source of failure for such epicardial systems. The authors hypothesized that a retrocostal surgical approach would reduce the rate of lead failure due to fracture compared with the more traditional subrectus and subxiphoid approaches. To evaluate this hypothesis, a retrospective chart review analyzed patients with epicardial pacemaker systems implanted or followed at Rady Children's Hospital San Diego between January 1980 and May 2007. The study cohort consisted of 219 patients and a total of 620 leads with epicardial pacemakers. Among these patients, 84% had structural congenital heart disease, and 45% were younger than 3 years at time of the first implantation. The estimated lead survival was 93% at 2 years and 83% at 5 years. The majority of leads failed due to pacing problems (54%), followed by lead fracture (31%) and sensing problems (14%). When lead failure was adjusted for length of follow-up period, no significant differences in the rates of failure by pocket location were found.

Citing Articles

Ischemic Heart Disease with In-Stent Re-Stenosis with Complete Heart Block and Isolated Persistent Left Superior Vena Cava - Rare Case Report with Challenges and Clinical Implications.

Yedurupaka S, Raj B, Prasad R Ann Card Anaesth. 2024; 27(3):270-273.

PMID: 38963367 PMC: 11315249. DOI: 10.4103/aca.aca_166_23.

Biventricular ICD Placement Percutaneously Via the Iliac Vein: Case Reports and a Review.

Higgins S J Innov Card Rhythm Manag. 2020; 8(7):2784-2789.

PMID: 32494460 PMC: 7252926. DOI: 10.19102/icrm.2017.080702.

Intraoperative localization of cardiac conduction tissue regions using real-time fibre-optic confocal microscopy: first in human trial.

Kaza A, Mondal A, Piekarski B, Sachse F, Hitchcock R Eur J Cardiothorac Surg. 2020; 58(2):261-268.

PMID: 32083653 PMC: 7594189. DOI: 10.1093/ejcts/ezaa040.

Old but not forgotten: Creative use of abandoned epicardial leads after more than 2 decades.

Bjorkman K, Clancy J, Elder R HeartRhythm Case Rep. 2018; 3(12):559-561.

PMID: 29296574 PMC: 5741798. DOI: 10.1016/j.hrcr.2017.05.006.

Minimally Invasive Epicardial Pacemaker Implantation in Neonates with Congenital Heart Block.

Costa R, Silva K, Martinelli Filho M, Carrillo R Arq Bras Cardiol. 2017; 109(4):331-339.

PMID: 28876373 PMC: 5644213. DOI: 10.5935/abc.20170126.

References

Thomson J, Blackburn M, Van Doorn C, Nicholls A, Watterson K . Pacing activity, patient and lead survival over 20 years of permanent epicardial pacing in children. Ann Thorac Surg. 2004; 77(4):1366-70. DOI: 10.1016/j.athoracsur.2003.08.057. View

Warner K, Halpin D, Berul C, PAYNE D . Placement of a permanent epicardial pacemaker in children using a subcostal approach. Ann Thorac Surg. 1999; 68(1):173-5. DOI: 10.1016/s0003-4975(99)00399-9. View

Fortescue E, Berul C, Cecchin F, Walsh E, Triedman J, Alexander M . Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm. 2005; 1(2):150-9. DOI: 10.1016/j.hrthm.2004.02.020. View

Silvetti M, Drago F, Grutter G, De Santis A, Di Ciommo V, Rava L . Twenty years of paediatric cardiac pacing: 515 pacemakers and 480 leads implanted in 292 patients. Europace. 2006; 8(7):530-6. DOI: 10.1093/europace/eul062. View

Maginot , Mathewson , Bichell , Perry . Applications of pacing strategies in neonates and infants. Prog Pediatr Cardiol. 2000; 11(1):65-75. DOI: 10.1016/s1058-9813(00)00037-0. View

Smerup M, Hjertholm T, Johnsen S, Pedersen A, Hansen P, Mortensen P . Pacemaker implantation after congenital heart surgery: risk and prognosis in a population-based follow-up study. Eur J Cardiothorac Surg. 2005; 28(1):61-8. DOI: 10.1016/j.ejcts.2005.04.007. View

Dodge-Khatami A, Kadner A, Dave H, Rahn M, Pretre R, Bauersfeld U . Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approach with excellent functional and cosmetic results. Eur J Cardiothorac Surg. 2005; 28(4):541-5. DOI: 10.1016/j.ejcts.2005.06.040. View

Gillette P, Zeigler V, Winslow A, Kratz J . Cardiac pacing in neonates, infants, and preschool children. Pacing Clin Electrophysiol. 1992; 15(11 Pt 2):2046-9. DOI: 10.1111/j.1540-8159.1992.tb03019.x. View

Antretter H, Colvin J, Schweigmann U, Hangler H, Hofer D, Dunst K . Special problems of pacing in children. Indian Pacing Electrophysiol J. 2006; 3(1):23-33. PMC: 1555629. View

10.

Cutler N, Karpawich P, Cavitt D, Hakimi M, Walters H . Steroid-eluting epicardial pacing electrodes: six year experience of pacing thresholds in a growing pediatric population. Pacing Clin Electrophysiol. 1998; 20(12 Pt 1):2943-8. DOI: 10.1111/j.1540-8159.1997.tb05464.x. View

11.

Epstein M, Walsh E, Saul J, Triedman J, Mayer Jr J, GAMBLE W . Long-term performance of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead. Pacing Clin Electrophysiol. 1998; 21(5):1098-104. DOI: 10.1111/j.1540-8159.1998.tb00156.x. View

12.

Silka M, Bar-Cohen Y . Pacemakers and implantable cardioverter-defibrillators in pediatric patients. Heart Rhythm. 2006; 3(11):1360-6. DOI: 10.1016/j.hrthm.2006.02.009. View

13.

Sachweh J, Schondube F, Daebritz S, Dorge H, Muhler E, Messmer B . Twenty years experience with pediatric pacing: epicardial and transvenous stimulation. Eur J Cardiothorac Surg. 2000; 17(4):455-61. DOI: 10.1016/s1010-7940(00)00364-x. View

14.

Cohen M, Rhodes L, Spray T, Gaynor J . Efficacy of prophylactic epicardial pacing leads in children and young adults. Ann Thorac Surg. 2004; 78(1):197-202. DOI: 10.1016/j.athoracsur.2004.02.008. View