Cardiac pacing problems in infants and children: results of a 4-year prospective study.
To evaluate cardiac pacing thresholds and the safety of a 2.5 V amplitude setting, we prospectively studied 29 pediatric patients during a mean follow-up of 16.4 months. Exit block (EB) at 2.5 V was confirmed during threshold analysis in 26% of 58 leads. No new cases were detected by threshold analysis after 20 weeks postimplantation. Exit block at 2.5 V occurred 4 times more frequently with ventricular than with atrial leads (39% vs 8%) and 11 times more frequently with epicardial than with endocardial leads (47% vs 4%). There was no relationship between intraoperative thresholds and EB during follow-up pacemaker checkups. The mean pulse width threshold (PWT) for endocardial ventricular leads was lower for steroid-tip than for non-steroid-tip leads (0.08 + 0.01 msec vs 0.28 + 0.04 msec). Exit block did not occur with steroid-tip leads. We conclude that during the first 20 weeks after implantation, a 2.5 V amplitude is not safe in children paced by means of nonsteroid epicardial ventricular leads. Our approach to pacing in children includes (1) 5.0 V amplitude for epicardial leads during the first 20 weeks after implantation and (2) use of endocardial steroid-tip leads whenever possible.
Villafañe
J
J
Department of Pediatrics, University of Louisville School of Medicine, Ky 40292.
Austin
E
E
D000293:Adolescent; D000305:Adrenal Cortex Hormones; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004560:Electricity; D004567:Electrodes, Implanted; D005260:Female; D006325:Heart Atria; D006327:Heart Block / Q000209:etiology*; D006352:Heart Ventricles; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D012684:Sensory Thresholds
D000305:Adrenal Cortex Hormones