Comparison of Two Myoepicardial Pacemaker Leads: Follow-up in 80 Children, Adolescents, and Young Adults

Although several types of commercially available epicardial leads exist, few postimplantation data have been reported. To compare "screw-in" (6917-35) leads with "stab-on" leads (4951-35) from the same manufacturer, we reviewed the records of 80 young patients (age 8 days to 29 years) who underwent ventricular epicardial pacemaker implantation from 1973 to 1986. Follow-up for the 57 patients with the 6917-35 model ranged from 3 months to 17 years (median 6.5 years) and for the 23 patients with the 4951-35 model 9 days to 4.25 years (median 2.0 years). Actuarial life table analysis revealed significantly (P less than 0.001) fewer 4951-35 leads were functioning at each of 1-5 years after implant, compared to the 6917-35 leads. Analysis of available threshold pulse width data revealed no difference (P = 0.08) acutely (6 weeks after implant), but a significantly (P = 0.05) higher mean threshold for the 4951-35 leads was found chronically. No significant correlation was found for lead failure with age, underlying heart disease, lead site (i.e., left or right ventricle), or surgical approach. Using the sutureless, stab-on technique, the 4951-35 lead is associated with higher thresholds and lower survival rate when compared to the 6917-35 lead.