title: An epicardial pacing safety net: an alternative technique for pacing in the young.
abstract: Epicardial pacing is the standard approach for permanent pacing in small children and patients with functionally univentricular physiology. The longevity of epicardial leads, however, is compromised by increased occurrences of exit block and lead fractures. We report our experience with a technique of placing a second ventricular lead, and attaching it to the atrial port of a dual chamber pacemaker to prevent the need for early re-operation in the event of failure of the primary epicardial lead. A retrospective review showed that, over the period from 2001 through 2007, epicardial ventricular pacemakers had been placed in 88 patients. In 6 of these, we had placed 2 ventricular leads, their median weight being 8.0 kilograms, with a range from 4.2 to 31.8 kilograms. Fracture of a lead occurred in 1 of the patients (17%) 8 months after placement, requiring reprogramming to pace from the atrial port. This possibility avoided the need for repeated emergent surgery. At a median follow-up of 1.5 years, with a range from 0.3 to 4.4 years, there have been no complications. During the same time period, overall failure of epicardial leads at our institution was 13%. Placement of a second ventricular epicardial pacing lead, attached to the atrial port of a dual chamber pacemaker, therefore, may provide a safe and effective means of ventricular pacing in the setting of epicardial lead failure, and may obviate the need for repeat, potentially urgent, pacemaker surgery.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, The Children's Hospital of New York, New York Presbyterian Hospital-Columbia University, New York, NY, USA. ceresnak@yahoo.com
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.forename: Leonardo
authors.initials: L
authors.lastname: Liberman
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Hordof
authors.forename: John J
authors.initials: JJ
authors.lastname: Lamberti
authors.forename: William J
authors.initials: WJ
authors.lastname: Bonney
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy; D054537:Atrioventricular Block / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004567:Electrodes, Implanted; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009519:New York City; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000628:therapy*; D016896:Treatment Outcome