title: Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children.
abstract: BACKGROUND
  Children requiring a permanent epicardial pacemaker (PM) traditionally have a single lead placed on the right ventricle. Lead failure in pacemaker-dependent (PMD) children, however, can result in cardiovascular events (CVEs) and death.
  
  
  OBJECTIVE
  The purpose of this study was to determine if redundant ventricular lead systems (RVLS) can safeguard against CVE and death in PMD children.
  
  
  METHODS
  This was a single-center study of PMD patients undergoing placement of RVLS from 2002-2013. Patients ≤21 years of age who were PMD were included. Patients with a biventricular (BiV) system placed for standard resynchronization indications were excluded. RVLS patients were compared to PMD patients with only a single pacing lead on the ventricle (SiV).
  
  
  RESULTS
  Seven hundred sixty-nine patients underwent PM/implantable cardioverter-defibrillator placement with 76 BiV implants; 49 patients (6%) were PMD. Thirteen patients underwent implantation of an RVLS. There was no difference between the RVLS group (n = 13) and SiV PMD control group (n = 24) with regard to age (RVLS 9.5 ± 5.8 years vs SiV 9.4 ± 6.7 years, P = .52), weight (RVLS 38.2 ± 32.6 kg vs SiV 35.2 ± 29.3 kg, P = .62), indication for pacing, procedural complications, or time to follow-up. There were 2 lead fractures (17%) in the RVLS group (mean follow-up 3.8 ± 2.9 years), with no deaths or presentations with CVE. The SiV control group had 3 lead fractures (13%) (mean follow-up 2.8 ± 2.9 years), with no deaths, but all 3 patients presented with CVE and required emergent PM placement.
  
  
  CONCLUSIONS
  RVLS systems should be considered in children who are PMD and require permanent epicardial pacing. BiV pacing and RVLS may decrease the risk of CVE in the event of lead failure in PMD patients.
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California. Electronic address: ceresnak@yahoo.com.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Perera
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Kara S
authors.initials: KS
authors.lastname: Motonaga
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Kishor
authors.initials: K
authors.lastname: Avasarala
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Malloy-Walton
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Debra
authors.initials: D
authors.lastname: Hanisch
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Punn
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Katsuhide
authors.initials: K
authors.lastname: Maeda
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Vadiyala Mohan
authors.initials: VM
authors.lastname: Reddy
authors.affiliation: Stanford Center for Clinical & Translational Research & Education, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Lan N
authors.initials: LN
authors.lastname: Doan
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kirby
authors.affiliation: Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dubin
mesh_terms: D000293:Adolescent; D058409:Cardiac Resynchronization Therapy Devices; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004567:Electrodes, Implanted; D004868:Equipment Failure; D005260:Female; D006327:Heart Block / Q000150:complications / Q000151:congenital* / Q000628:therapy; D006352:Heart Ventricles; D006801:Humans; D008297:Male
keywords: Biventricular pacing; Children; Pacemaker dependent; Pediatrics; Sudden death