title: Comparative Chronic Valve and Venous Effects of Lumenless versus Stylet-Delivered Pacing Leads in Patients with and Without Congenital Heart.
abstract: BACKGROUND
  Standard, 5-7-Fr diameter pacing leads (PLs) can adversely affect atrioventricular valve (AVV) and venous (superior vena cava [SVC], innominate [INN]) integrities. Although chronic pacing/sensing performances have been reported on the steroid-eluting, lumenless, 4.1-Fr PL (Model 3830, Medtronic Inc., Minneapolis, MN, USA), comparative valve and venous effects are largely unknown.
  
  
  METHODS
  Patients (n = 134) were divided into two PL groups: Group 1 (n = 65, Model 3830) and Group 2 (n = 69, various 5-7 Fr models) and followed up to 9 years postimplant. Patient demographics, clinical findings, valve function, and venous dimensions were reviewed. Statistical significance was defined as P < 0.05.
  
  
  RESULTS
  Patient implant age (mean 16.4 years vs 17.3 years), presence of congenital heart defect (CHD), and preexisting valve issues were comparable between groups. New or worsening valve insufficiency occurred in 12% of Group 1 patients (mean follow-up 4.3 ± 2.8 years) and 27% of Group 2 patients (mean follow-up 6.2 ± 3.5 years; P < 0.05). Significant SVC or INN narrowing was found in 11 % of Group 1 and 24% of Group 2 patients (P = 0.0004). All Group 1 patients <12 years of age showed normal while 50% of those from Group 2 exhibited stunted SVC or INN growth (P < 0.05).
  
  
  CONCLUSIONS
  The lumenless, 4.1-Fr diameter PL offers improved clinical benefits, better AVV integrity, and venous development compared with larger 5-7-Fr diameter PL and should be considered especially in younger patients with/without CHD.
authors.affiliation: Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Apinya
authors.initials: A
authors.lastname: Bharmanee
authors.affiliation: Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Zelin
authors.affiliation: Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Yamuna
authors.initials: Y
authors.lastname: Sanil
authors.affiliation: Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Pooja
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Karpawich
mesh_terms: D000293:Adolescent; D000328:Adult; D016122:Brachiocephalic Trunk; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006349:Heart Valve Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D014261:Tricuspid Valve; D014652:Vascular Diseases / Q000209:etiology*; D014683:Vena Cava, Superior; D055815:Young Adult
keywords: clinical; echocardiography; electrophysiology; pacing; pediatrics