title: Equivalent performance of epicardial versus endocardial permanent pacing in children: a single institution and manufacturer experience.
abstract: BACKGROUND
  Children requiring permanent pacing have a lifelong need for follow-up. Epicardial leads have traditionally fared worse than endocardial counterparts. We tested the hypothesis that steroid-eluting epicardial and endocardial leads had equivalent outcomes.
  
  
  METHODS
  We reviewed medical records of 148 children, mean age 8.2 +/- 4.8 years, in whom a dual-chamber pacemaker system with steroid-eluting leads from a single manufacturer was implanted. Primary outcome was mortality. Secondary outcomes included freedom from lead failure and pacemaker system reintervention. Loss of capture-sensing, lead displacement-fracture, exit block, and high thresholds constituted lead failure. Reintervention included need for lead revision or generator change.
  
  
  RESULTS
  There was no early mortality. Late mortality occurred once (0.5 +/- 0.5 deaths/1,000 patient-months) and eight times (3.4 +/- 1.2 deaths/1,000 patient-months) in the endocardial and epicardial groups, respectively. The relative hazard of endocardial versus epicardial site for lead failure was 0.408 (p = 0.038) and for reintervention was 0.629 (p = 0.002). Endocardial and epicardial groups differed in important ways: concomitant cardiac surgery 5% (3 of 61) versus 27% (27 of 99); congenital heart disease 33% (20 of 61) versus 90% (89 of 99); single ventricle physiology 13% (8 of 61) versus 52% (51/99); and age (10.5 +/- 4.5 years vs 5.5 +/- 5.2 years). Adjusting for these covariants, the relative hazard for freedom from lead failure for endocardial versus epicardial leads was 0.546 (p = 0.360). The adjusted relative hazard for freedom from reintervention was 0.157 (p = 0.045).
  
  
  CONCLUSIONS
  Technologic advances attenuate important differences in lead failure rates between endocardial and epicardial steroid-eluting pacing leads and thus bridge the performance gap between these fixation modes.
authors: Division of Cardiac Surgery, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, USA. odimj@niaid.nih.gov
authors: Jonah
authors: J
authors: Odim
authors: Bjoern
authors: B
authors: Suckow
authors: Babak
authors: B
authors: Saedi
authors: Hillel
authors: H
authors: Laks
authors: Kevin
authors: K
authors: Shannon
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003257:Consumer Product Safety; D004699:Endocardium; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D010138:Pacemaker, Artificial; D010496:Pericardium; D011336:Probability; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome