Document Detail


Predictors affecting durability of epicardial pacemaker leads in pediatric patients.
MedLine Citation:
PMID:  18242269     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Despite pacemaker therapy in children and adolescents favoring an initial epicardial approach, predictors of lead failure have not been well clarified. The aim of this study was to assess the long-term outcomes and to determine predictors affecting lead durability in pediatric pacing therapy. METHODS: We reviewed the outcomes of 109 consecutive pacing leads implanted in 55 patients (median age, 5.2 years; range, 31 days-15.8 years), including 38 atrial and 71 ventricular leads. They consisted of 58 (53%) fishhooks, 37 (34%) screw-in leads, and 14 (13%) steroid-eluting suture-on leads. Seventy (64%) were implanted in patients with structural heart disease. RESULTS: The leads were followed for a median of 6.4 years (range, 3 days-22.9 years). Lead failure occurred in 29 leads (27%; median of 8.4 years after implantation). Exit block or elevation of pacing threshold was the most common cause (n = 18), but failures did not directly cause patient death. The overall 1-, 5-, 10-, and 15-year lead survivals were 100%, 89.0%, 72.5%, and 55.5%, respectively. Multivariate Cox analysis revealed concurrent structural heart disease (relative risk, 2.85; 95% confidence interval, 1.27-6.42; P = .011) to be the only significant predictor of lead failure. CONCLUSIONS: Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease.
Authors:
Hiroomi Murayama; Masanobu Maeda; Hajime Sakurai; Akihiko Usui; Yuichi Ueda
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  135     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-03-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  361-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Social Insurance Chukyo Hospital, Nagoya, Japan. romiwo@mcn.ne.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Arrhythmias, Cardiac / diagnosis*,  etiology,  mortality,  therapy*
Cardiac Pacing, Artificial / methods*
Child
Child, Preschool
Cohort Studies
Electrocardiography
Electrodes, Implanted*
Equipment Failure
Equipment Safety
Female
Follow-Up Studies
Heart Defects, Congenital / complications
Humans
Infant
Infant, Newborn
Male
Multivariate Analysis
Pacemaker, Artificial*
Probability
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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