title: A 12-year experience of bipolar steroid-eluting epicardial pacing leads in children.
abstract: BACKGROUND
  Cardiovascular abnormalities and small vascular size may preclude transvenous pacing and necessitate epicardial lead implantation. This study evaluates the performance of steroid-eluting, bipolar epicardial pacing leads.
  
  
  METHODS
  We prospectively enrolled 114 children with 239 atrial and ventricular bipolar epicardial leads (Medtronic CapSure 10366 or 4968, Minneapolis, MN), followed up to 12.2 years (median, 3.2). Lead data were obtained at implant and at semi-annual visits. Analysis was done for left or right atrial and ventricular leads.
  
  
  RESULTS
  Median atrial and ventricular pacing thresholds remained below 1.2 V at 0.5 ms. Thresholds did not differ between pacing sites: left atrial, 0.82 V at 0.5 ms; right atrial, 0.74 V at 0.5 ms (p = 0.85); and left ventricular, 0.96 V at 0.5 ms; right ventricular, 0.94 V at 0.5 ms (p = 0.65). Sensing demonstrated no difference for atrial leads, at left atrial, 3.4 mV; and right atrial, 2.9 mV (p = 0.12), but there was superiority of left over right ventricular leads (11.2 vs 7.7 mV, p = 0.002). During follow-up, the 239 atrial and ventricular leads experienced 19 (8%) lead failures. Lead survival at 2 and 5 years was 99% and 94% for atrial leads and 96% and 85% for ventricular leads, respectively.
  
  
  CONCLUSIONS
  Bipolar steroid-eluting epicardial leads demonstrate excellent sensing characteristics and persistent low median pacing thresholds below 1.2 V at 0.5 ms in children during up to 12 years follow-up. Considering growing and active patients with most having congenital heart disease, the lead survival of 85% to 94% at 5 years is favorable. Subanalysis shows superior sensing for left ventricular leads. Bipolar steroid-eluting leads provide an alternative approach for permanent pacing and may also be considered for left atrial and ventricular pacing, resynchronization, or defibrillator therapy.
authors.affiliation: Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland. maren.tomaske@kispi.uzh.ch
authors.forename: Maren
authors.initials: M
authors.lastname: Tomaske
authors.forename: Bart
authors.initials: B
authors.lastname: Gerritse
authors.forename: Leo
authors.initials: L
authors.lastname: Kretzers
authors.forename: Rene
authors.initials: R
authors.lastname: Pretre
authors.forename: Ali
authors.initials: A
authors.lastname: Dodge-Khatami
authors.forename: Mariette
authors.initials: M
authors.lastname: Rahn
authors.forename: Urs
authors.initials: U
authors.lastname: Bauersfeld
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D003907:Dexamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004562:Electrocardiography; D004567:Electrodes, Implanted; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D010496:Pericardium / Q000503:physiopathology; D013686:Telemetry
chemical_list: C004180:dexamethasone 21-phosphate; D003907:Dexamethasone