Ventricular lead redundancy to prevent cardiovascular events and sudden death from lead fracture in pacemaker-dependent children.

Autor:	Ceresnak SR; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California. Electronic address: ceresnak@yahoo.com., Perera JL; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Motonaga KS; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Avasarala K; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Malloy-Walton L; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Hanisch D; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Punn R; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Maeda K; Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Reddy VM; Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Doan LN; Stanford Center for Clinical & Translational Research & Education, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Kirby K; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California., Dubin AM; Division of Pediatric Cardiology, Pediatric Electrophysiology, Department of Pediatrics, Stanford University-Lucile Packard Children's Hospital, Palo Alto, California.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2015 Jan; Vol. 12 (1), pp. 111-6. Date of Electronic Publication: 2014 Sep 30.
DOI:	10.1016/j.hrthm.2014.09.056
Abstrakt:	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. Conclusion: 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. (Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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