title: Cardiac strangulation following epicardial pacemaker implantation: a rare pediatric complication.
abstract: OBJECTIVE
  The aim of our study was 2-fold: to determine the incidence of cardiac strangulation (CS) and to develop a clinical pathway to aid in the diagnosis and prognosis of CS. In <2 years, 2 cases of CS occurred in our institution, which caused much alarm and led to the study's objectives.
  
  
  METHODS
  All patients who underwent implantation of an epicardial pacemaker from January 1992 to March 2012 were included. There were no exclusion criteria. Health records were used to locate all subjects and gather all retrospective data. Prospectively, subjects without a chest radiograph from the previous 2 years were approached for imaging.
  
  
  RESULTS
  This study included 86 patients retrospectively, and 84 patients prospectively. There was a 2.3% incidence, and a 1.2% mortality, related to CS. A pattern of posterior looping of the ventricular lead was seen in radiographs of both CS-diagnosed patients. Five variables were significantly associated with an outcome of CS (P = .0153).
  
  
  CONCLUSIONS
  Our data indicate that the 2 cases of CS were not caused by a lack of follow-up but by a lack of consistent imaging for diagnosis. This conclusion is supported by the 8 cases of CS found in the English-language literature. If the patient is age ≤6 months at the time of implantation, particular attention should be given to the placement of leads and follow-up.
authors.affiliation: Division of Pediatric Cardiovascular and Thoracic Surgery, Department of Surgery, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Carreras
authors.affiliation: Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Cardiology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Duncan
authors.affiliation: Department of Measurement & Reporting, Provincial Health Service Authority, Vancouver, British Columbia, Canada.
authors.forename: Ognjenka
authors.initials: O
authors.lastname: Djurdjev
authors.affiliation: Division of Pediatric Cardiovascular and Thoracic Surgery, Department of Surgery, BC Children's Hospital, Provincial Health Services Authority, Vancouver, British Columbia, Canada; Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: acampbell@cw.bc.ca.
authors.forename: Andrew I M
authors.initials: AI
authors.lastname: Campbell
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects; D004868:Equipment Failure; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017202:Myocardial Ischemia / Q000209:etiology* / Q000401:mortality; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D055815:Young Adult