Permanent epicardial pacing in pediatric patients - Seventeen years of experience and 1200 outpatient visits

Background-The purpose of this study was to evaluate the long-term outcome of all pediatric epicardial pacing leads. Methods and Results-All epicardial leads and 1239 outpatient visits between January 1, 1983, and June 30, 2000, were retrospectively reviewed. Pacing and sensing thresholds were reviewed at implant, at 1 month, and at subsequ ent 6-month intervals. Lead failure was defined as the need for replacement or abandonment due to pacing or sensing problems, lead fracture, or phreni c/muscle stimulation. A total of 123 patients underwent 207 epicardial lead (60 atrial/147 ventricular, 40% steroid) implantations (median age at impl ant was 4.1 years [range 1 day to 21 years]). Congenital heart disease was present in 103 (84%) of the patients. Epicardial leads were followed for 29 months (range 1 to 207 months), The 1-, 2-, and 5-year lead survival was 9 6%: 90%, and 74%, respectively. Compared with conventional epicardial leads , both atrial and ventricular steroid leads had better stimulation threshol ds 1 month after implantation; however, only ventricular steroid leads had improved chronic pacing thresholds (at 2 years: for steroid leads, 1.9 muJ [from 0.26 to 16 muJ]; for nonsteroid leads, 4.7 muJ [from 0.6 to 25 muJ]; P<0.01). Ventricular sensing was significantly better in steroid leads 1 mo nth after lead implantation (at 2 years: for steroid leads, 8 mV [from 4 to 31 mV]; for nonsteroid leads, 4 mV [from 0.7 to 10 mV]; P<0.01). Neither c ongenital heart disease, lead implantation with a concomitant cardiac opera tion, age or weight at implantation, nor the chamber paced was predictive o f lead failure. Conclusions-Steroid epicardial leads demonstrated relatively stable acute a nd chronic pacing and sensing thresholds. In this evaluation of >200 epicar dial leads, lead survival was good, with steroid-eluting leads demonstratin g results similar to those found with historical conventional endocardial l eads.