title: Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease.
abstract: OBJECTIVE
  Atrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients.
  
  
  RESULTS
  We evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P< 0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41%, atrioventricular septal defect 11%, tetralogy 9%, ventricular septal defect 8%), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50%), atrioventricular block (38%), cardiomyopathies, and primary ventricular arrhythmias (12%). Leads are steroid-eluting (98%), tined (59%), screw-in (41%), polyurethane-insulated (72%), silicone-insulated (28%), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50%), right atrial free wall/septum (25%), left atrium (s/p Mustard, 25%). Follow-up duration is 6.4 ± 4.8 (range 0.1-18) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5%) (P= 0.03); 16 leads (14%) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P= 0.03) positioned outside RAA (P= 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P< 0.001), impedance showed a decrease (0.6 Ω/month, P< 0.001), P-wave showed no significant difference.
  
  
  CONCLUSIONS
  Transvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period.
authors.affiliation: Paediatric Arrhythmology Unit and Syncope Unit, Paediatric Cardiology and Heart-Surgery Department, Bambino Gesù Children's Hospital, IRCCS Rome, Italy. mstefano.silvetti@opbg.net
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.forename: Lucilla
authors.initials: L
authors.lastname: Ravà
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000628:therapy*; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult