title: Efficacy of prophylactic epicardial pacing leads in children and young adults.
abstract: BACKGROUND
  Epicardial pacemakers are often required in children and young adults who cannot undergo a transvenous system because of patient size, vascular barriers, or significant residual intracardiac shunts. Prophylactic epicardial pacing leads, placed at the time of concomitant congenital heart surgery, may reduce a late thoracotomy or sternotomy. The efficacy of prophylactic epicardial leads in the pediatric population is unknown.
  
  
  METHODS
  A retrospective review of the cardiovascular surgery and pacemaker databases at The Children's Hospital of Philadelphia identified all patients less than or equal to 21 years of age, who underwent placement of an epicardial pacing lead between January 1, 1990 and December 31, 2002. Prophylactic epicardial pacing leads placed at the time of a concomitant congenital heart procedure were compared to standard epicardial leads that were connected to a simultaneous programable generator. Pacing and sensing threshold data were obtained in prophylactic epicardial leads at the time of lead retrieval and 6 month follow-up and compared to standard epicardial pacing leads.
  
  
  RESULTS
  Twenty-two (13 ventricular, 9 atrial) prophylactic epicardial pacing leads were retrieved in 13 patients at a median of 252 days (7 days to 3.98 years) from the time of initial implant and compared to 256 (164 ventricular, 92 atrial) standard epicardial leads placed in 142 patients. Nineteen (86%) prophylactic epicardial leads had acceptable pacing and sensing thresholds at lead retrieval. Only 1 patient with atrial and ventricular leads had poor pacing and sensing at retrieval and required a redo-sternotomy for placement of new atrial and ventricular epicardial pacing leads. For the remaining atrial (n = 7) and ventricular (n = 12) prophylactic epicardial leads, there was no significant difference in pacing (atrial, 1.59 +/- 1.1 microJ; ventricular, 1.98 +/- 1.9 microJ) or sensing (atrial, 3.6 +/- 1.8 mV; ventricular, 13.8 +/- 4.4 mV) compared to standard pacing (atrial, 2.1 +/- 1.8 microJ; ventricular, 1.9 +/- 3.4 microJ) and sensing (atrial, 3.3 +/- 1.7 mV; ventricular, 11.3 +/- 5.3 mV) epicardial leads. Six-month follow-up pacing and sensing thresholds were not significantly different between the prophylactic and standard epicardial pacing leads.
  
  
  CONCLUSIONS
  Prophylactic epicardial pacing leads can be successfully placed and retrieved in a subset of children and young adults who will likely require pacing at a later date. Prophylactic leads have comparable pacing and sensing qualities at lead retrieval and short-term follow-up compared to standard epicardial leads. Consideration for prophylactic epicardial pacing leads will likely reduce the need for a late thoracotomy or sternotomy.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. mitchapcc@360express.com
authors.forename: Mitchell I
authors.initials: MI
authors.lastname: Cohen
authors.forename: Larry A
authors.initials: LA
authors.lastname: Rhodes
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000517:prevention & control / Q000628:therapy*; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D017097:Electric Impedance; D004567:Electrodes, Implanted; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006327:Heart Block / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D011183:Postoperative Complications / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy / Q000706:statistics & numerical data