title: Bipolar lumenless lead performance in children and adults with congenital heart disease.
abstract: BACKGROUND
  Because of small size and anatomic variation, implantation of intracardiac leads for permanent pacing in pediatric and congenital heart disease (CHD) patients can be challenging. A novel 4.1F bipolar catheter-delivered lead offers potential advantages for this population. OBJECTIVE; The purpose of this study was to retrospectively evaluate this lead performance in this specific population.
  
  
  METHODS
  We performed a retrospective descriptive analysis of all pediatric and adult CHD patients at a single center implanted with a 4.1F bipolar catheter-delivered active fixation pacemaker lead (Medtronic model 3830, Medtronic, Inc, Minneapolis, MN, USA).
  
  
  RESULTS
  Over 10 months, 42 leads were implanted in 27 patients. Twenty-six atrial and 16 ventricular leads were placed. Patient ages were 1-28 years (mean 15 +/- 7), and weights were 7.8-104 kg (mean 51.5 +/- 26.6). Ventricular septal defect and D-transposition of great arteries were the most prevalent CHD diagnoses. Implant capture thresholds were 1.2 +/- 0.8 V at 0.5 ms in the atrium and 0.8 +/- 0.5 V at 0.5 ms in the ventricle. Implant sensing thresholds were 4.1 +/- 2.7 mV in the atrium and 12.1 +/- 4.9 mV in the ventricle. Phrenic nerve stimulation was avoided in all, and selective site pacing was achieved in most cases. Pacing and sensing thresholds remained stable during 90 +/- 52 days follow-up. No lead related complications, failures, or extractions were observed.
  
  
  CONCLUSIONS
  In our single-center experience with pediatric and CHD patients, a novel small, catheter-delivered bipolar lead has proven safe and effective for atrial and ventricular pacing in acute and subacute time periods. Longer performance trends will be required to determine chronic efficacy.
authors.affiliation: Division of Cardiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah 84158, USA.
authors.forename: Marcos
authors.initials: M
authors.lastname: Daccarett
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Segerson
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Susan P
authors.initials: SP
authors.lastname: Etheridge
authors.forename: Roger A
authors.initials: RA
authors.lastname: Freedman
authors.forename: Elizabeth Vickers
authors.initials: EV
authors.lastname: Saarel
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D004567:Electrodes, Implanted; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000628:therapy; D055815:Young Adult