Do daily threshold trend fluctuations of epicardial leads correlate with pacing and sensing characteristics in paediatric patients?
OBJECTIVE
To evaluate whether the magnitude of daily ventricular pacing threshold fluctuations (Deltafluctuation) in trend graphs of stored diagrams correlate with ventricular threshold and sensing changes over time.


RESULTS
A total of 56 children received AutoCapture devices (St. Jude Medical, Sylmar, CA, USA) connected to steroid-eluting epicardial leads. Maximum lead age at study closure was 12.2 years (median 4.0). Telemetry data and daily Deltafluctuation were obtained every 6 months. Regression slope coefficients and mean values of repeated measurements were calculated for each patient's course. High daily Deltafluctuation correlated with higher pacing thresholds (rho = 0.68, P < 0.001), lower impedances (rho = -0.38, P = 0.004), and a Deltafluctuation-incline (rho = 0.34, P = 0.01) over time. Furthermore, a Deltafluctuation-incline correlated with a pacing threshold-incline (rho = 0.34, P = 0.01). No correlation was observed for ventricular sensing. Higher daily Deltafluctuation were observed if lead age was > 5 years compared with <or= 5 years (0.75 vs. 0.55 V@0.5 ms, P = 0.028).


CONCLUSIONS
High amplitudes of daily Deltafluctuation correlate with higher and increasing pacing thresholds and lower impedances. Theoretically, this results from electrode microinstability on the epicardial surface. A decrease of the steroid-eluting potency of the electrode can be hypothesized to cause higher daily Deltafluctuation beyond a lead age of 5 years. Potential implications of marked daily Deltafluctuation are short-term follow-up and lead replacement in the presence of high pacing thresholds.
Tomaske
Maren
M
Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland. maren.tomaske@kispi.unizh.ch
Harpes
Paul
P
Dodge-Khatami
Ali
A
Amacker
Nadja
N
Bauersfeld
Urs
U
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004056:Differential Threshold; D004562:Electrocardiography / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D010496:Pericardium; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013813:Therapy, Computer-Assisted / Q000379:methods*; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000517:prevention & control*