title: Risk factors for venous obstruction in children with transvenous pacing leads.
abstract: To determine the incidence and risk factors for venous obstruction in children with transvenous pacing leads, 63 children were evaluated clinically and echocardiographically. Patients with abnormal clinical and/or echocardiographic findings were further investigated by venography. Thirteen patients (21%) had evidence of venous obstruction. Venography in 11 (2 refused) showed that severity of obstruction (as defined by percentage of luminal narrowing) was complete (100%) in 3, severe (> 90%) in 4, and moderate (60%-90%) in 5 (1 patient having 2 sites of obstruction). Risk factors for obstruction in 55 patients with single implantation procedures (10 with obstruction; 18%) were sought. Total cross-sectional area of lead(s) was indexed to body surface area at implantation (INDEX). Patients with obstruction had a higher mean INDEX (7.6 +/- 1.6 mm2/m2) than patients without obstruction (4.9 +/- 2.0 mm2/m2); P < 0.0002). Receiver-operator characteristic curves showed an INDEX > 6.6 mm2/m2 to best predict obstruction, with a sensitivity of 90% and specificity of 84%. Since pacing is lifelong, sizing of transvenous leads to the child is important to prevent obstruction and preserve venous access.
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: F H
authors.initials: FH
authors.lastname: Figa
authors.forename: B W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: J L
authors.initials: JL
authors.lastname: Bigras
authors.forename: R M
authors.initials: RM
authors.lastname: Hamilton
authors.forename: R M
authors.initials: RM
authors.lastname: Gow
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010690:Phlebography; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014680:Veins / Q000473:pathology*