Chronic Performance of Steroid-Eluting Epicardial Leads in a Growing Pediatric Population:. A 10-Year Comparison (original) (raw)
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Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group
Heart (British Cardiac Society), 2002
To compare the performance of steroid eluting epicardial and endocardial leads in infants and children requiring permanent pacing. Evaluation of pacing and sensing characteristics, impedances, and longevity of 159 steroid eluting leads implanted in 95 children. Group A consisted of 24 children weighing less than 15 kg with 15 endocardial leads (five atrial, 10 ventricular) and 19 epicardial leads (five atrial, 14 ventricular). Group B consisted of 71 children weighing more than 15 kg with 106 endocardial leads (56 atrial, 58 ventricular) and 19 epicardial leads (nine atrial, 10 ventricular). Group A: Stimulation thresholds were lower for ventricular endocardial leads at implant (mean (SD) 0.84 (0.54) v 1.59 (0.64) V, p < 0.014) and at two year follow up (ventricular 0.64 (0.24) v 1.65 (0.69) V, p < 0.003). Impedance and sensing thresholds did not differ significantly at implant and follow up. Group B: Stimulation thresholds were lower for ventricular endocardial leads at impla...
A Comparison of Steroid-Eluting Epicardial versus Transvenous Pacing Leads in Children
Journal of Cardiac Surgery, 2000
Objective: To evaluate the acute and chronic performance of steroid-eluting (SE) epicardial (EPI) pacing leads as compared t o SE transvenous (TV) pacing leads in children. Methods: From 1989 through 1997,55 children with congenital heart disease received a t o t a l of 85 SE pacing leads, of which 38 were EPI and 47 TV. The mean age of children receiving EPI leads was younger than those receiving TV leads (7.7 months vs 15.1 years, p = 0.0011, and they had shorter follow-up (17.2 months vs 36.2 months, p e 0.001). All leads were evaluated for acute and chronic sensing and capture thresholds, and impedance. Results: Acute and in particular chronic atrial and ventricular sensing and capture thresholds in SE EPI and TV leads were essentially equivalent.
Steroid-Eluting Epicardial Leads in Pediatrics: Improved Epicardial Thresholds in the First Year
Pacing and Clinical Electrophysiology, 1991
From 1986 to 1991, we evaluated the clinical use of three new epicardial lead designs incorporating a steroid-eluting electrode. Medtronic models SP2114 (bipolar high profile), 10320 (bipolar low profile), 10295A/4965 (unipolar low profile) steroid epicardial (SE) leads were used on either atrium or ventricle for a total of 21 lead placements in 17 patients. Energy thresholds (T) were calculated and compared with our most recent 16 nonsteroid epicardial (NE) Medtronic model 4951 lead implants for which T was available. SE leads demonstrated no acute T rise and continued T improvements at 1 year of follow-up. We conclude that epicardial application of SE lead technology offers a major improvement in pacing lead function and potential pacemaker longevity over NE leads in pediatric patients in whom endocardial pacing is precluded by size or anatomy.
Pacing and Clinical Electrophysiology, 1997
Thresholds in a Growing Pediatric Population. Indications for pacemaker implantation in the pediatric population often include sinus or atrioventricular node dysfunction following surgery for congenital heart defects. However, patient size, cardiac defects, and vascular and valvular concerns may limit transvenous lead utilization. Since the epicardial surface of these patients often exhibits variable degrees of fibrosis from scar tissue formation or pericardial adhesions, chronic low output (2.5/1.6 V, 0.3 ms) epicardial pacing from implant is not currently recommended in children due to frequent threshold changes and electrode exit block. As a result, pacing in children is often viewed as a less efficient system than in adults. The addition of steroid combined with newer low threshold electrode designs however stabilizes the electrode-tissue interface and eliminates postimplant changes seen with standard smooth surface electrodes potentially permitting efficient chronic pacemaker application to all patient ages. The stability of chronic low output epicardial pacing with steroid-eluting electrodes was prospectively studied in 22 patients (ages 2 days-18.5 years, median 3.5 years) for up to 6 years. Chronic pulse width thresholds were compared according to implant site and association of prior cardiac surgery. A total of 26 pacing leads were implanted. The acute implant mean pulse width threshold (2.5 V) for all the electrodes studied was 0.10 ms ± 0.05 ms. Stable low thresholds were maintained for up to 6 years without significant variation from implant. Mean ventricular pulse width thresholds (0.12 ms ± 0.05 ms) were significantly higher (P < 0.001) than atrial thresholds (0.06 ms ± 0.03 ms) at implant and throughout the study period. The thresholds in the patients following cardiac surgery were comparable to those without previous cardiac surgery (P = NS). Stable low thresholds may be chronically maintatined for up to 6 years for epicardia! steroid-eluting electrodes irrespective of pacing site or associated cardiac surgery
Active-fixation, steroid-eluting ventricular leads: the medium-term results in children
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2005
Low threshold characteristics and mechanical stability are important features of an ideal pacing lead, especially for children. We report our experience and medium-term results with a steroid-eluting, active-fixation ventricular lead in children. Telectronics Accufix II DEC model 033-212 ventricular leads were implanted in 21 patients. Eighteen patients (11 male / 7 female; 10.6+/-4.0 years), who were followed for a mean period of 6.47 +/-1.13 years, were included in the study. Pacemaker mode was DDDR in three patients, and VVIR in the remaining 15 patients. Mean threshold value was 0.5 volts at implant, which increased to 0.7 volts in the first month (p>0.05). It remained stable (0.62-0.78 V) until 5.5 years (p>0.05), increased significantly at 5.5 years (0.99+/-0.63 V at 5.5 years, p<0.05) and remained significantly high after this time (p<0.05). Pacing lead impedance did not differ significantly throughout the study (p>0.05). Thirteen pulse generators reached end-o...
Circulation, 2001
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 subsequent 6-month intervals. Lead failure was defined as the need for replacement or abandonment due to pacing or sensing problems, lead fracture, or phrenic/muscle stimulation. A total of 123 patients underwent 207 epicardial lead (60 atrial/147 ventricular, 40% steroid) implantations (median age at implant 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 96%, 90%, and 74%, respectively. Compared with conventional epicardial leads, both atrial and ventricular steroid leads had better stimulation thresholds 1 month after implantation; however, only ventricular steroid leads had improved chronic pacing thresholds (at 2 years: for steroid leads, 1.9 J [from 0.26 to 16 J]; for nonsteroid leads, 4.7 J [from 0.6 to 25 J]; PϽ0.01). Ventricular sensing was significantly better in steroid leads 1 month 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]; PϽ0.01). Neither congenital heart disease, lead implantation with a concomitant cardiac operation, age or weight at implantation, nor the chamber paced was predictive of lead failure. Conclusions-Steroid epicardial leads demonstrated relatively stable acute and chronic pacing and sensing thresholds. In this evaluation of Ͼ200 epicardial leads, lead survival was good, with steroid-eluting leads demonstrating results similar to those found with historical conventional endocardial leads. (Circulation. 2001;103:2585-2590.)
Chronic Performance of a Transvenous Steroid Pacing Lead Used as an Epi-Intramyocardial Electrode
Pacing and Clinical Electrophysiology, 1998
KARPAWICH, P.P., ET AL.: Chronic Performance of a Transvenous Steroid Pacing Lead Used as an Epiintramyocardial Electrode. Excessive surface fibrosis or fat limits effective electrode insertion in patients requiring epicardial pacing. We present chronic performance of a modified transvenous steroid lead used as an epi-intramyocardiai electrode in a patient following repair of a univentricular heart after failure of both standard and steroid-eluting epicardial leads. Low implant threshold values remained stable during a 3-year postimplant interval demonstrating an effective and innovative approach to epicardial pacing. (PACE 1998; 21:1486-1488
Pacing and Clinical Electrophysiology, 2000
CEVIZ, N., ET AL: Comparison of Mid-term Clinical Experience with Steroid-Eluting Active and Passive Fixation Ventricular Electrodes in Children. Although active fixation ventricular leads seem to have advantages over passive fixation leads, this study compares the follow-up results of active and passive fixation leads in children. We evaluated the implantation and follow-up data of 41 children with active (Accufix II DEC, group 1) (n = 20) or passive (Membrane E. group 2) (n = 21) fixation, steroid-eluting ventricularleads. All but one of the patients in group 1 completed the 12-month follow-up. The mean follow-up period in group 2 was 10.4 ± 2.9 months (range 3-12 months, median 12 months). In both groups the mean pacing threshold was measured as 0.51 ± 0.09 V versus 0.48 ± 0.15 V (P > 0.05) at 0.5-ms pulse width, mean R wave amplitude as 9.9 ± 2.5 mV versus 9.4 ± 3.2 mV (P > 0.05), and mean impedance as 557 i 92 il versus 664 ± 160 (2 (P < 0.05), respectively, at implantation. After the first week of pacing, mean threshold values in group 1 were significantly lower than those of group 2 (P < 0.01 and P < 0.05, respectively). During the follow-up period, lead impedance measurements did not show a significant difference between the two groups. In one patient from group 1. the lead (by unscrewing) was removed easily because of pacemaker pocket infection. No lead dislodgement or helix deformation occurred in group 1. Nevertheless, in one patient from group 2, the lead was extracted at 4-month postimplantation because of lead displacement. We conclude that the steroid-eluting active fixation lead (Accufix II DEC) have advantages of easier implantation and lower acute and chronic stimulation thresholds compared to the passive fixation lead (Membrane E). Therefore, Accufix II DEC is superior to Membrane E, and it is a better first choice in children with an implanted single chamber ventricular pacemaker. (PACE 2000; 23:1245-1249 steroid elution, active fixation lead, passive fixation lead, children Address for reprints: Alpay Celiker, M.D., Cardiology Unit. Department
Pacing and Clinical Electrophysiology, 1999
long-term atrial and ventricular electrical performance of a new generation using a very small surface area (1.2 mnf) steroid-eluting electrode (Medtronic CapSure Z). We compared the performance of CapSure Z to that of traditional passive fixation leads, with and without steroid elution. The study was conducted during 2 years of follow-up. We studied 188 patients (105 males and 83 females; mean age 71 ± 7 years). All of the patients were implanted with a dual chamber pacemaker and the same type of lead in both chambers. Forty-one patients received CapSure Z leads, 25 patients received Target Tip leads (8-mm^ surface area; no steroid elution), 63 patients received CapSure leads (8-mm^ surface area; steroid elution), and 59 patients received CapSure SP leads (5.8-mm^ surface area; steroid elution). The four groups were homogeneous in regards to sex, age, cardiac disease, and reason for implant.At follow-up, the CapSure Z lead showed sensing values comparable to the other leads, with lower pacing thresholds and higher pacing impedance in both chambers. We evaluated the mean current drained from the pacemaker by the different types of leads when using safe, low energy output settings. We found that by using CapSure Z leads, the mean current was significantly lower than that of the other types of leads (0.42 jiA for CapSure Z ventricular lead vs 0.85 for CapSure SP, 1.42 for CapSure, and 1.54 for Target Tip). Thus, the use of the CapSureZ lead, combined with low energy output programming, will increase pacemaker longevity compared to the use of traditional leads and standard output programming.UPACE 1999; 22.326-334}