Comparison of longevity, paging, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children

Objective: Because of either cardiac anatomy or small size, pacing in child ren often occurs by means of epicardial leads. The disadvantage of epicardi al leads is the shorter longevity of these leads compared with endocardial leads. During short-term follow-up, improved stimulation thresholds were fo und for the newer steroid-eluting epicardial leads. The longevity of these leads may be better than that of conventional epicardial leads. An improved longevity of epicardial leads may influence the choice to either epicardia l or endocardial pacing in children. Methods: We studied the longevity and the pacing and sensing characteristics of 33 steroid-eluting epicardial pac ing leads (group I, 15 atrial, 18 ventricular) implanted between November 1 991 and October 1996 in 20 children with a mean age of 7.6 +/- 6.5 years (m ean +/- SD), and 29 endocardial pacing leads (group II, 15 atrial, 14 ventr icular) implanted during the same period in 21 children with a mean age of 11.7 +/- 4.7 years. Results: The mean follow-up in group I was 2.9 +/- 1.6 years and in group II 3.1 +/- 1.7 years (P =.61). The 2-year survival of th e leads in group I was 91% +/- 5% and in group II 86% +/- 7% (P =.97). Lead failure occurred in both groups in 4 leads (P =.85). Chronic stimulation a nd sensing thresholds were similar. Conclusions: Steroid-eluting epicardial leads have the same longevity as the conventional endocardial leads. Pacin g and sensing thresholds were similar and did not change during follow-up, Therefore steroid-eluting epicardial pacing leads are a good alternative fo r endocardial leads in small children and in children with congenital heart disease.