Transmural Atrial Pacing in Patients with Postoperative Congenital Heart Disease (original) (raw)
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Circulation. Arrhythmia and electrophysiology, 2014
Many patients with congenital heart disease require permanent pacing for rhythm management but cannot undergo transvenous lead placement. In others, epicardial scarring prohibits adequate sensing and pacing thresholds using epicardial leads. This study describes long-term lead performance using a transmural atrial (epicardial to endocardial) pacing approach in patients with congenital heart disease. For transmural atrial (TMA) lead access, a bipolar, steroid-eluting transvenous lead was placed from the epicardium via purse-string incision or atriotomy and affixed to atrial endocardium. Records were reviewed for patient data and acute and long-term lead performance for TMA leads placed 1998 to 2004. Forty-two of 48 TMA leads remain active at last follow-up. Two leads fractured, 4 were functional at >5-year follow-up but no longer active. Freedom from lead failure 98% (95% confidence interval, 86%-100%) at mean follow-up 7.8 years. TMA leads gave excellent sensing and pacing charac...
Technical Aspects of Pacing in Adult and Pediatric Congenital Heart Disease
Pacing and Clinical Electrophysiology, 2008
As intuitive as it might appear, it must be remembered that children are not little adults and congenital heart defects do not equate to normal cardiac anatomy. In addition, repaired congenital heart defects in adults (ACHD) might also not equate to normal anatomy. In each of these clinical situations, pacemaker device therapy may dramatically differ from most of the published information available in the field of internal medicine cardiology. Since there are now more patients with structural congenital heart defects over than under the age of 21 years, all present and future generations of pacemaker implanters need to recognize the plethora of anatomical and structural nuances potentially associated with the implantation of device therapy in this continually expanding patient population. Fortunately, advances in pacemaker and lead technology over the past 20 years, which now permit precise implantation at selective endocardial sites other than the right ventricular apex or atrial appendage and improved epicardial leads, have greatly facilitated optimization of pacing therapy. Whereas past interests have focused on lead performance issues such as dislodgement, fractures, and exit block, improvements in lead design technologies now permit more interest in maintaining or improving paced myocardial function by optimizing lead placement at alternate or more select sites. This article reviews recent applications and future directions of these pacing technologies and emphasizes differences among patients with congenital heart defects. (PACE 2008; 31:S28-S31) congenital heart disease, pediatrics, adult congenital heart, pacemaker, pacing leads, alternate site pacing, cardiac resynchronization pacing, heart block, septal pacing, His bundle pacing
Circulation Reports
Background: Little is known about the acute/long-term outcomes of implantation of cardiac implantable electronic devices (CIED) using a transvenous approach for patients with congenital heart disease (CHD). Methods and Results: We retrospectively investigated the acute/long-term results and complications associated with transvenous CIED implantation in 140 patients with CHD. We implanted 77 pacemakers, 51 implantable cardioverter defibrillators (ICD), and 12 cardiac resynchronization therapy (CRT) devices. Although we successfully implanted pacemakers and ICD in all patients, we could not place a coronary sinus (CS) lead in 25% of the patients requiring CRT devices due to coronary vein anomalies associated with corrected transposition of the great arteries (cTGA). Overall complication rate, lead failure rate, and incidence of device infection were 16%, 9%, and 0.7%, respectively. There was no significant difference in overall complication rates between the simple (n=22) and complex CHD (n=118) groups (14% vs. 16%). The 10-year lead survival for the ICD leads (77%) was significantly lower than for the pacemaker leads (91%, P=0.0065). Conclusions: The outcomes of transvenous CIED in patients with CHD seemed acceptable, although there was a relatively high incidence of complications. CS lead placement for cTGA may be hindered by coronary vein anomalies. Lead survival tended to be lower for ICD than for pacemakers in these patients.
Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial?
Europace, 2013
Cardiac pacing is a difficult technique in children, particularly in patients with congenital heart defects (CHDs). Few studies to date have addressed this topic. We performed a retrospective analysis of the results of a single centre. Between 1982 and 2008, 287 patients with CHD, median age of 5 years (25-75%, 1-11) underwent cardiac pacing for sinus node dysfunction (SND) and atrioventricular block (AVB); 97% of patients underwent at least one heart surgery. Endocardial systems (Endo) were implanted in 117 patients, epicardial systems (Epi) in 170, with 595 leads (228 Endo, 367 Epi). Endocardial systems showed a significantly older age group with more frequent SND; Epi a younger age group, with more frequent AVB, greater number of surgical interventions. Perioperative complications were mortality 0.6% (Epi), pericardial effusion 0.6% (Epi), and haemothorax 3.4% (Endo). The median follow-up is 5 (2-10) years: the pacing system failed in 29% of patients, 13% Endo, and 40% Epi (P < 0.0001). Multivariate analysis showed a significantly higher risk of failure for Epi, a lower implant age, greater the number of leads implanted. The risk of malfunction of the leads increases significantly for Epi and the younger age when implanted. The steroid-eluting leads have a lower risk of malfunction (P = 0.05), steroid-eluting Endo leads provide significantly better outcomes than Epi. Cardiac pacing in paediatric patients with CHD shows satisfactory results in the long term. Endocardial systems show significantly better results than Epi systems. A younger age when implanted is a risk factor for complications at follow-up.
Permanent transfemoral pacemaker insertion after repair of congenital heart disease
Annals of Thoracic Surgery, 1991
In certain patients with anomalies of systemic venous connection, traditional transvenous pacemaker lead insertion may not be technically feasible. We report the use of the femoral venous approach to insert a permanent pacemaker in a patient with congenital heart disease who had undergone two previous cardiac operations and had n the majority of adult patients, transvenous permanent I pacemaker insertion can be accomplished; however, there are certain situations in which anomalies of the superior venous circulation complicate access to the right ventricle by this route. In these cases, transvenous pacemaker failure is common and epicardial pacing is frequently used [ 1-31. Epicardial pacing has several disadvantages compared with transvenous pacing, including higher pacing thresholds and increased complexity and risk during insertion, especially in patients who have undergone previous cardiac procedures . In these select cases, transvenous permanent pacing through the femoral vein may be advantageous. We report the successful placement of a permanent femoral transvenous pacing lead in a young adult patient with complex cardiovascular anomalies who had undergone multiple cardiac operations and who required permanent cardiac pacing.
Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 2011
We evaluate the incidence of epicardial lead failure and try to identify risk factors in patients with congenital heart disease. All patients with a congenital heart defect and an epicardial pacing system, implanted within a timeframe of 25 years, were included in this study. Patients' medical records and lead data were reviewed. Lead failure was defined as the primary endpoint. In total 198 active epicardial leads (atrial 40, ventricular 158) were implanted in 93 patients (median age at implantation 4.4 years (range 0-58.6)). During a total follow-up of 1235 lead-years, 29 lead failures (14.6%, 4 atrial, 25 ventricular) were documented in 22 patients (23.7%). Lead failure occurred at a median time period of 4.8 years (range 1.2-24.1) after implantation. Five-year freedom of lead failure was 88%. The only independent predictor for lead failure was the age at implantation (HR 0.44; 95%CI 0.20-0.97, p = 0.04), other characteristics failed to predict lead failure. Sudden cardiac de...
Europace, 2012
Atrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients. Methods and results We evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P , 0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41%, atrioventricular septal defect 11%, tetralogy 9%, ventricular septal defect 8%), aged 13.3 + 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50%), atrioventricular block (38%), cardiomyopathies, and primary ventricular arrhythmias (12%). Leads are steroid-eluting (98%), tined (59%), screw-in (41%), polyurethane-insulated (72%), silicone-insulated (28%), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50%), right atrial free wall/septum (25%), left atrium (s/p Mustard, 25%). Follow-up duration is 6.4 + 4.8 (range 0.1-18) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5%) (P ¼ 0.03); 16 leads (14%) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P ¼ 0.03) positioned outside RAA (P ¼ 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P , 0.001), impedance showed a decrease (0.6 V/month, P , 0.001), P-wave showed no significant difference. Conclusions Transvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period.
Pacing and Clinical Electrophysiology, 2019
Introduction: The Medtronic SelectSecure TM pacing lead (SS) has theoretical advantages compared to conventional (C) transvenous pacing leads (PL). The study purpose was to determine whether differences in electrical function and lead survival exist between these PL in a large data set of pediatric and congenital patients. Methods: A multicenter historical longitudinal cohort study was performed comparing SS and CPL performance over a 72-month follow-up (FU). Ten centers provided data for both SS and CPL, matched for age, implanted pacing chamber, time period of implantation, and presence of heart disease. Results: The cohort consisted of 141 subjects in each group. No statistical differences were observed in age, gender, presence of heart disease, or pacing indication. Atrial and ventricular capture thresholds were stable throughout FU and higher in the SS group (
Pacing and Clinical Electrophysiology, 1995
RHODES, L.A., ET AL.: Benefits and Potential Risks of Atrial Antitachycardia Pacing After Repair of Congenital Heart Disease. Atrial reentry tachycardia is common after surgical repair of congenital heart disease. The arrhythmia is often difficult to treat and is occasionally life-threatening. This study reports experience with atrial antitachycardia (AAITmode) pacing for the management of atrial reentry tachycardia, with emphasis on the risks and benefits of automatic pacing therapy. Eighteen patients (2-32 years of age) with a variety of congenital heart lesions underwent atrial antitachycardia pacemaker placement for recurrent atrial tachycardia that was amenable to pace termination prior to the implantation procedure. An appropriate antitachycardia program was determined by repeated induction and termination of atrial tachycardia using the noninvasive programmed stimulation mode of the pacemaker. Over 4-30 months offoUow-up, 6 patients had 189 episodes of tachycardia successfully converted with AAI-T pacing, 4 patients had 8 episodes of tachycardia detected but not successfully converted, and 8 patients had no episodes of tachycardia with antibradycardia pacing alone. The number of patients receiving pharmacological therapy other than digoxin or beta blockade fell from 12 to 6. Two subjects died suddenly, 1 while wearing a Holter monitor. In both, tachycardia was detected and pace cardioversion attempted. Conclusions." Atrial antitachyardia pacing is a useful tool in the management of patients with congenital heart disease and atrial arrhythmias; however, in selected cases, it may not prevent and may even exacerbate the lethal complications ofthe tachycardia. Antitachycardia function evaluation is recommended under varying levels of autonomic stress prior to institution of automatic therapy.