Long-term experience with AutoCapture-controlled epicardial pacing in children.
OBJECTIVE
To examine the feasibility and safety of AutoCapture (AC)-controlled pacing with epicardial leads in children, and study the effects on device longevity.


METHODS
A total of 62 children were prospectively enrolled. Pre-discharge testing precluded AC function in six children. In 56 (90%) children, devices with AC-controlled pacing were followed up to 9years. Calculated battery life in AC-controlled pacing was compared with theoretical calculations, using a two-fold stimulation output of measured thresholds.


RESULTS
In 53 of 56 children, no differences were observed for evoked response signals (13.3 vs. 11.5mV, P = 0.20) or lead polarization safety margins (5.5 vs. 4.1, P = 0.25) at 6-month and 4-year follow-up. A crossover to conventional pacing was required in 3 of 56 children. AC-controlled pacing prolonged the calculated battery life up to 15% for the identity and integrity devices with 0.95A h capacity, compared with theoretical conventional settings (P = 0.008). In patients with ventricular pacing thresholds >1.5V at 0.5ms, battery life was increased by 30% compared with theoretical conventional settings (P < 0.001).


CONCLUSIONS
AC-controlled pacing with epicardial leads is feasible and safe in children during long-term follow-up. An adequate lead polarization safety margin persists in most patients. Calculated battery life was prolonged up to 15% with AC-controlled pacing. Patients with high or fluctuating pacing thresholds benefit the most.
Tomaske
Maren
M
Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland. maren.tomaske@kispi.uzh.ch
Harpes
Paul
P
Pretre
Rene
R
Dodge-Khatami
Ali
A
Bauersfeld
Urs
U
D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium; D013813:Therapy, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome