Epicardial pacing: a single-centre study on 321 leads in 138 patients.
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.
Ector
Bavo
B
Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium.
Willems
Rik
R
Heidbüchel
Hein
H
Gewillig
Marc
M
Mertens
Luc
L
Meyns
Bart
B
Daenen
Willem
W
Ector
Hugo
H
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
D020099:Coated Materials, Biocompatible; D005938:Glucocorticoids; D003907:Dexamethasone