Optimal position of atrial epicardial leads for temporary pacing in infants after cardiac surgery

Background. The atrial epicardial wall of pediatric patients was topographi cally assessed to identify the optimal position for temporary atrial pacing . Methods. Unipolar electrodes were fixed at the cephalic wall between the ri ght and left atrial appendages, the interatrial groove, and the right atria l appendage of fifteen pediatric patients who underwent definitive surgical repair. The performance of the three electrodes in terms of pacing pattern s and six combinations of bipolar pacing were evaluated in terms of the pac ing threshold, P-wave amplitude, slew rate, and lead impedance. Results. Unipolar pacing of the right atrial appendage showed a significant ly higher threshold than the other groups. A bipolar configuration of the c ephalic atrial wall and interatrial groove had a significantly higher P-wav e amplitude than groups without the electrode at the cephalic atrial wall, and a significantly higher slew rate than a unipolar configuration of the a trial appendage. Conclusions. Bipolar pacing with the negative electrode at the cephalic atr ial wall and the indifferent electrode at the interatrial groove is the mos t efficient method for pediatric patients. (C) 2001 by The Society of Thora cic Surgeons. (C) 2001 by The Society of Thoracic Surgeons.