OBJECTIVES: To examine outcomes of children with pacemakers over a 22-year period and identify risk factors for lead failure. BACKGROUND: Small patient size, structural cardiac abnormalities, and growth may complicate pediatric pacemaker management. Better knowledge of risk factors for lead failure in these patients may help improve future outcomes. METHODS: All pacemaker patients followed at one pediatric center 1980-2002 were included. Lead failures were identified retrospectively as leads repaired, replaced, or abandoned due to fracture, insulation break, dislodgement, or abnormalities in pacing or sensing. Risk factors were identified using logistic regression and Cox analyses. RESULTS: A total of 1007 leads were implanted in 497 patients during the study period (5175 lead-years). Median age at implant was 9 years (0-55); 64% of patients had structural congenital heart disease. Median follow-up time was 6.2 years (0-22). Lead failure occurred in 155 leads (15%), and 115 patients (23%), with 28% of patients experiencing multiple failures. Significant independent correlates of lead failure included age <12 years at implant, history of structural congenital heart defects, and epicardial lead placement. Younger patients (<12 years) experienced significantly more lead fractures than older children (P = .005), while patients with congenital heart defects experienced more exit block. Epicardial leads were more likely to fail due to fracture or exit block, while transvenous leads failed more due to insulation breaks or dislodgements. CONCLUSIONS: Pediatric pacing patients have a high incidence lead failures. These occur most commonly in younger patients, structural congenital heart disease, and those with epicardial lead systems. Approaches to pacing system implantation and follow-up in these patients need to be individualized, with special attention to minimizing risk of lead failures. Our findings suggest that expanded utilization of transvenous systems in smaller patients seems justified when anatomy permits.
OBJECTIVES: To examine outcomes of children with pacemakers over a 22-year period and identify risk factors for lead failure. BACKGROUND: Small patient size, structural cardiac abnormalities, and growth may complicate pediatric pacemaker management. Better knowledge of risk factors for lead failure in these patients may help improve future outcomes. METHODS: All pacemaker patients followed at one pediatric center 1980-2002 were included. Lead failures were identified retrospectively as leads repaired, replaced, or abandoned due to fracture, insulation break, dislodgement, or abnormalities in pacing or sensing. Risk factors were identified using logistic regression and Cox analyses. RESULTS: A total of 1007 leads were implanted in 497 patients during the study period (5175 lead-years). Median age at implant was 9 years (0-55); 64% of patients had structural congenital heart disease. Median follow-up time was 6.2 years (0-22). Lead failure occurred in 155 leads (15%), and 115 patients (23%), with 28% of patients experiencing multiple failures. Significant independent correlates of lead failure included age <12 years at implant, history of structural congenital heart defects, and epicardial lead placement. Younger patients (<12 years) experienced significantly more lead fractures than older children (P = .005), while patients with congenital heart defects experienced more exit block. Epicardial leads were more likely to fail due to fracture or exit block, while transvenous leads failed more due to insulation breaks or dislodgements. CONCLUSIONS: Pediatric pacing patients have a high incidence lead failures. These occur most commonly in younger patients, structural congenital heart disease, and those with epicardial lead systems. Approaches to pacing system implantation and follow-up in these patients need to be individualized, with special attention to minimizing risk of lead failures. Our findings suggest that expanded utilization of transvenous systems in smaller patients seems justified when anatomy permits.
Authors: Thomas J Oxley; Nicholas L Opie; Sam E John; Gil S Rind; Stephen M Ronayne; Tracey L Wheeler; Jack W Judy; Alan J McDonald; Anthony Dornom; Timothy J H Lovell; Christopher Steward; David J Garrett; Bradford A Moffat; Elaine H Lui; Nawaf Yassi; Bruce C V Campbell; Yan T Wong; Kate E Fox; Ewan S Nurse; Iwan E Bennett; Sébastien H Bauquier; Kishan A Liyanage; Nicole R van der Nagel; Piero Perucca; Arman Ahnood; Katherine P Gill; Bernard Yan; Leonid Churilov; Christopher R French; Patricia M Desmond; Malcolm K Horne; Lynette Kiers; Steven Prawer; Stephen M Davis; Anthony N Burkitt; Peter J Mitchell; David B Grayden; Clive N May; Terence J O'Brien Journal: Nat Biotechnol Date: 2016-02-08 Impact factor: 54.908
Authors: Sarah Chambers; Alex Rusanov; Henry M Spotnitz; Eric S Silver; Leonardo Liberman Journal: J Interv Card Electrophysiol Date: 2011-02-16 Impact factor: 1.900
Authors: Li Zhou; Yaniv Bar-Cohen; Raymond A Peck; Giorgio V Chirikian; Brett Harwin; Ramen H Chmait; Jay D Pruetz; Michael J Silka; Gerald E Loeb Journal: Cardiovasc Eng Technol Date: 2017-01-09 Impact factor: 2.495
Authors: Geoffrey D Huntley; Abhishek J Deshmukh; Carole A Warnes; Suraj Kapa; Alexander C Egbe Journal: Pediatr Cardiol Date: 2018-06-14 Impact factor: 1.655
Authors: Brian J Lichtenstein; David P Bichell; Dana M Connolly; John J Lamberti; Suzanne M Shepard; Stephen P Seslar Journal: Pediatr Cardiol Date: 2010-08-06 Impact factor: 1.655