Exit block in pediatric cardiac pacing. Comparison of the suture-type and fishhook epicardial electrodes.
Ninety-seven consecutive permanent epicardial pacemaker implantations were performed with either suture-type (group I, n = 52) or fishhook electrodes (group II, n = 45). In addition to epicardial fixation of the electrodes at the collar area, the suture-type was further secured in place by tying the electrode's suture at its exit to another nonabsorbable pledget-supported suture. Acute thresholds and slew rates were not significantly different between the two groups. Although the R wave was lower in group I (8.4 +/- 3.5 mV) than in group II (11.8 +/- 6, p less than 0.01), no sensing problems occurred. The larger surface area of suture-type electrode led to lower resistance in group I (271 +/- 61 omega) compared with group II (356 +/- 72, p less than 0.001); however, the difference in pacemaker generator longevity did not appear significant (group I, n = 12, mean 4.7 +/- 1.6 years; group II, n = 4, mean 5 +/- 0.6 years). The incidence of exit block was significantly higher in group II (40%, 18/45) than in group I (8%, 4/52, p less than 0.01). The length of the stimulation tip and better fixation of the suture-type electrode probably accounted for the observed difference in the incidence of exit block between the two electrodes.
DeLeon
S Y
SY
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614.
Ilbawi
M N
MN
Backer
C L
CL
Idriss
F S
FS
Paul
M H
MH
Zales
V R
VR
Benson
D W
DW
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000151:congenital* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004553:Electric Conductivity; D004567:Electrodes, Implanted; D004867:Equipment Design; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality; D006801:Humans; D007223:Infant; D010138:Pacemaker, Artificial; D015996:Survival Rate