Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group.
OBJECTIVE
To compare the performance of steroid eluting epicardial and endocardial leads in infants and children requiring permanent pacing.


METHODS
Evaluation of pacing and sensing characteristics, impedances, and longevity of 159 steroid eluting leads implanted in 95 children. Group A consisted of 24 children weighing less than 15 kg with 15 endocardial leads (five atrial, 10 ventricular) and 19 epicardial leads (five atrial, 14 ventricular). Group B consisted of 71 children weighing more than 15 kg with 106 endocardial leads (56 atrial, 58 ventricular) and 19 epicardial leads (nine atrial, 10 ventricular).


RESULTS
Group A: Stimulation thresholds were lower for ventricular endocardial leads at implant (mean (SD) 0.84 (0.54) v 1.59 (0.64) V, p < 0.014) and at two year follow up (ventricular 0.64 (0.24) v 1.65 (0.69) V, p < 0.003). Impedance and sensing thresholds did not differ significantly at implant and follow up. Group B: Stimulation thresholds were lower for ventricular endocardial leads at implant (0.72 (0.48) v 1.48 (0.58) V, p < 0.001) and at follow up (0.88 (0.46) v 1.55 (0.96) V, p < 0.009). Impedance did not differ. Sensing thresholds were also better for ventricular endocardial leads at follow up (9.1 (5.2) v 14.2 (6.4) mV, p < 0.02). Complications requiring intervention occurred in both groups (n = 7 for endocardial v n = 18 for epicardial leads).


CONCLUSIONS
Endocardial and epicardial steroid eluting leads have comparable performance in the paediatric population.
Udink ten Cate
F
F
Wilhelmina Children's Hospital, Utrecht, Netherlands.
Breur
J
J
Boramanand
N
N
Crosson
J
J
Friedman
A
A
Brenner
J
J
Meijboom
E
E
Sreeram
N
N
D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D002307:Cardiography, Impedance / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013256:Steroids / Q000627:therapeutic use*
D013256:Steroids