title: Alternative delivery of a 4Fr lumenless pacing lead in children.
abstract: BACKGROUND
  The potential advantages of using a 4Fr lumenless pacing lead (3830 SelectSecure, Medtronic Inc, Minneapolis, MN, USA) in children are largely negated due to the large size of the delivery system. Here we describe an innovative, sheath guided, delivery technique using conventional 5F sheaths.
  
  
  METHODS
  Transvenous access was obtained via the left cephalic or axillary vein. A 5Fr introducer set with a 45 degrees curved tip (CheckFlo Performer Introducer Set with the Children's Hospital Boston Modification, Cook Medical Inc, Bloomington, IN, USA) was placed over a wire into the right atrium (RA) or right ventricle (RV). The sheath was modified by cutting off the valved end and a SelectSecuretrade mark lead was introduced through the sheath. Rotating the sheath provided steerability and allowed for precise placement of the lead. After successful lead placement, the sheath was removed with a universal sheath splitter.
  
  
  RESULTS
  We placed seven atrial and six ventricular leads in eight patients during nine separate cases with this method. Patient ages and weights ranged from 5 to 16 years and 16 to -59 kg respectively. Pacing thresholds were excellent at implant. Leads were placed successfully in all attempts. There were no procedural complications. One patient had leads placed twice; both lead systems were removed for suspected infection. Over short-term follow-up in five patients, lead position and characteristics have remained stable.
  
  
  CONCLUSIONS
  Delivery of the SelectSecure lead in children can be successfully and precisely performed using a modified 5Fr sheath obviating the need for a large steerable delivery system.
authors.affiliation: Washington University School of Medicine, Department of Pediatrics, Division of Pediatric Cardiology, St. Louis, Missouri, USA. lapage_m@kids.wustl.edu
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Lapage
authors.forename: Edward K
authors.initials: EK
authors.lastname: Rhee
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome