Initial experience of pacing with a lumenless lead system in patients with congenital heart disease.
BACKGROUND
Long-term pacing is frequently necessary in patients with congenital heart disease (CHD). Preservation of ventricular function and avoidance of venous occlusion is important in these patients. Site-selective pacing with a smaller diameter lead is achievable with the model 3830 lead (SelectSecure, Medtronic Inc., Minneapolis, MN, USA), which was specifically designed to target these complications. We describe our initial experience with the Model 3830 lead in patients with CHD.


METHODS
Retrospective analysis of all patients undergoing site-selective implantation of a Model 3830 lead(s) from two congenital heart centers (Bristol, UK, and Dublin, Ireland) from October 2004 until February 2008.


RESULTS
We implanted 139 SelectSecure leads (atrial n=70; ventricular n=69) in 90 patients (57 male) with CHD. Median age at implantation: 13.4 years (1.1-59.2 years), median weight: 43 kg. Sixty-nine patients (76%) were children (<18 years). Indications for lead implantation included atrioventricular block (n=55), sinus node disease (n=18), implantable cardiac defibrillator (n=12), antitachycardia pacing (n=4), and cardiac resynchronization (n=1). Twenty-two patients underwent pre-existing lead extraction during the same procedure. All the attempted procedures resulted in successful pacing. One patient had a significantly raised threshold at implantation. There was no procedural mortality. There were two procedural complications. Three patients required lead repositioning for increasing thresholds early postprocedure (<6 weeks). Four leads (2.9%) had displaced on median follow-up of 21.8 months (0.5-42 months).


CONCLUSIONS
The Model 3830 lead is safe and effective in patients with CHD. This is a technically challenging patient group yet procedural complication and lead displacement rates are acceptable.
Chakrabarti
Santabhanu
S
Bristol Congenital Cardiac Centre, Bristol Royal Hospital for Children, Bristol, UK.
Morgan
Gareth J
GJ
Kenny
Damien
D
Walsh
Kevin P
KP
Oslizlok
Paul
P
Martin
Robin P
RP
Turner
Mark S
MS
Stuart
A Graham
AG
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D010865:Pilot Projects; D012189:Retrospective Studies; D055815:Young Adult