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Masanobu Maeda
Hajime Sakurai
Akihiko Usui
Yuichi Ueda
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Right arrow Congenital - cyanotic
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J Thorac Cardiovasc Surg 2008;135:361-366
© 2008 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Predictors affecting durability of epicardial pacemaker leads in pediatric patients

Hiroomi Murayama, MDa,*, Masanobu Maeda, MDa, Hajime Sakurai, MDa, Akihiko Usui, MDb, Yuichi Ueda, MDb

a Department of Cardiovascular Surgery, Social Insurance Chukyo Hospital, Nagoya, Japan
b Department of Cardio-Thoracic Surgery, Nagoya University, Nagoya, Japan.

Received for publication July 23, 2007; revisions received September 6, 2007; accepted for publication September 13, 2007.

* Address for reprints: Hiroomi Murayama, MD, the Department of Thoracic and Cardiovascular Surgery, Toyohashi Municipal Hospital, Toyohashi, Japan. (Email: romiwo{at}mcn.ne.jp).

Objectives: Despite pacemaker therapy in children and adolescents favoring an initial epicardial approach, predictors of lead failure have not been well clarified. The aim of this study was to assess the long-term outcomes and to determine predictors affecting lead durability in pediatric pacing therapy.

Methods: We reviewed the outcomes of 109 consecutive pacing leads implanted in 55 patients (median age, 5.2 years; range, 31 days–15.8 years), including 38 atrial and 71 ventricular leads. They consisted of 58 (53%) fishhooks, 37 (34%) screw-in leads, and 14 (13%) steroid-eluting suture-on leads. Seventy (64%) were implanted in patients with structural heart disease.

Results: The leads were followed for a median of 6.4 years (range, 3 days–22.9 years). Lead failure occurred in 29 leads (27%; median of 8.4 years after implantation). Exit block or elevation of pacing threshold was the most common cause (n = 18), but failures did not directly cause patient death. The overall 1-, 5-, 10-, and 15-year lead survivals were 100%, 89.0%, 72.5%, and 55.5%, respectively. Multivariate Cox analysis revealed concurrent structural heart disease (relative risk, 2.85; 95% confidence interval, 1.27–6.42; P = .011) to be the only significant predictor of lead failure.

Conclusions: Epicardial leads provide a reliable technique for managing rhythmic disturbance problems in the pediatric population. The only significant predictor of lead failure is the presence of structural heart disease.

Abbreviations and Acronyms S-CHD = structural congenital cardiac disease






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