title: Epicardial pacing: a single-centre study on 321 leads in 138 patients.
abstract: OBJECTIVE
  This study presents the long-term outcome of 321 epicardial leads in 138 patients.
  
  
  RESULTS
  All leads were Medtronic CapsureEpi model 4965 steroid eluting leads. The 1-, 3-, and 5-year patient survival was 91%, 83% and 77%, respectively.Twenty-seven patients died. In 25/27 deaths a pacing-related death could be excluded. Strangulation of the heart by an abandoned epicardial lead was the cause of death in one child. One other patient died suddenly at the age of 3 years. Failures occurred in 57 of 321 epicardial leads (18%). For all 321 leads, the 1-, 3- and 5-year freedom from failure was 91%, 85% and 71%, respectively. The cumulative proportion of patients without any lead defect was 85% after I year, 76% after 3 years and 62% after 5 years. The percentage of patients without serious adverse events at 1, 3, and 5 years was 97%, 91%, 85%, respectively. Lead fracture was the cause of failure in 15 leads of 9 patients. An important increase in pacing threshold occurred in 35 leads of 30 patients. Other failures were: diaphragmatic stimulation, infection, excessive traction and strangulation. Eighteen failures were repaired by 11 surgical interventions in 9 patients.Thirty-nine defects were corrected non-invasively in 31 patients.
  
  
  CONCLUSIONS
  The use of steroid-eluting epicardial leads has proven to be an adequate option. In paediatric cardiology, the epicardial approach remains an indispensable tool for achieving a life-long pacing.
authors.affiliation: Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium.
authors.forename: Bavo
authors.initials: B
authors.lastname: Ector
authors.forename: Rik
authors.initials: R
authors.lastname: Willems
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbüchel
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
authors.forename: Luc
authors.initials: L
authors.lastname: Mertens
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.forename: Willem
authors.initials: W
authors.lastname: Daenen
authors.forename: Hugo
authors.initials: H
authors.lastname: Ector
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003907:Dexamethasone / Q000008:administration & dosage; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006327:Heart Block / Q000401:mortality / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000401:mortality / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010496:Pericardium; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis
chemical_list: D020099:Coated Materials, Biocompatible; D005938:Glucocorticoids; D003907:Dexamethasone