Experience with a low profile bipolar, active fixation pacing lead in pediatric patients.
Continued miniaturization of permanent pacing systems has promoted use of this technology in younger and smaller pediatric patients. Intermedics ThinLine 438-10 active fixation pacing leads (4.5 Fr lead body) were implanted in 26 patients (17 males/9 females; 9.9 +/- 6.9 years). Twenty of 26 patients received dual chamber systems, 6 of 26 patients single lead systems. Each patient has been followed 3 months. Pacemaker analysis at implant and 6 months later evaluated pulse width thresholds at 2.5 V (atrial 0.07 +/- 0.02 vs 0.13 +/- 0.02 ms [P = 0.01]; ventricular 0.08 +/- 0.04 ms vs 0.20 +/- 0.04 ms [P = 0.01]); sensing thresholds (atrial 4.1 +/- 0.41 mV vs 4.0 +/- 4.2 mV [P = NS]; ventricular 9.7 +/- 0.72 vs 9.3 +/- 0.94 mV [P = NS]); and impedance (atrial 345 +/- 12 vs 370 +/- 120 O [P = 0.04]; ventricular 412 +/- 17 vs 458 +/- 190 O [P < 0.01]). One volt lead failed with exit block at approximately 6 weeks. The youngest (9 months to 5 years) and smallest (6.5-18.0 kg) ten patients have each shown by venography to have at least mild venous stenosis at the lead(s) insertion site; five patients demonstrated collateral formation around asymptomatic obstruction, with no thrombus formation. The Intermedics 438-10 ThinLine pacing lead has demonstrated good and stable early postimplant electrical parameters. Angiographic evaluation in our smaller patients has shown evidence for asymptomatic venous obstruction.
Campbell
R M
RM
Children's Heart Center at Egleston Scottish Rite, Atlanta, Georgia, USA. donofriov@Kidsheart.com
Raviele
A A
AA
Hulse
E J
EJ
Auld
D O
DO
McRae
G J
GJ
Tam
V K
VK
Kanter
K R
KR
D000293:Adolescent; D000328:Adult; D001283:Atrioventricular Node / Q000601:surgery; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging; D002304:Cardiac Pacing, Artificial; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008133:Long QT Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008452:Maximum Allowable Concentration; D010138:Pacemaker, Artificial / Q000592:standards*; D010690:Phlebography; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging