Precipitous exit block with epicardial steroid-eluting leads
| Autor: | Richard A. Hopkins, Dan R. Mans, Karen S. Kuehl, Lisa M. Tonder, Stanley D. Beder |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Tachycardia
Adult Male medicine.medical_specialty Adolescent Exit Block Electrocardiography Predictive Value of Tests Internal medicine medicine Humans In patient Treatment Failure Lead (electronics) Child Glucocorticoids Retrospective Studies medicine.diagnostic_test business.industry Cardiac Pacing Artificial Infant Retrospective cohort study General Medicine Middle Aged medicine.disease Surgery Electrodes Implanted Heart Block Predictive value of tests Heart failure Child Preschool Cardiology Tachycardia Ventricular Female medicine.symptom Cardiology and Cardiovascular Medicine business Pericardium Follow-Up Studies |
| Zdroj: | Pacing and clinical electrophysiology : PACE. 20(12 Pt 1) |
| ISSN: | 0147-8389 |
| Popis: | Between January 1990 and October 1992, we implanted 16 steroid-eluting ventricular epicardial pacing leads (Medtronic 10295A and 10295B/4965) in 12 patients. There were 8 males and 4 females ranging in age from 3 months to 49 years (mean 8.7 +/- 13.2, median 6.0 years). Structural cardiac disease was present in 11 of 12 patients. Follow-up ranged from 3-73 months postimplant (mean 35.7 +/- 22.3, median 28.5 months). Lead fracture (10295A) occurred in 1 of 12 patients. Of the remaining 11 patients, 8 of 11 have very low long-term pacing thresholds. Unexpectedly, 3 patients demonstrated precipitous threshold increases from 3 months to 3.5 years postimplant. Although no deaths resulted in these exit block patients, 1 of 3 exit block patients developed marked worsening of congestive heart failure. We reviewed and analyzed the data obtained at 4 weeks postimplant for all of the 10295A and 4965 patients in the entire Medtronic clinical study database. Using the criterion of a 4 week postimplant pacing threshold > or = 0.12 ms (5 V), we found that the long-term risk of eventual exit block was 27.3% for the 10295A lead (P = 0.005) and 7.5% for the 10295B/4965 lead (P = 0.03). We, therefore, recommend that in patients implanted with the 4965 steroid-eluting epicardial lead, ventricular pacing thresholds > or = 0.12 ms (5 V) measured at 4 weeks postimplant should prompt frequent threshold testing to detect late and potentially sudden ventricular pacing threshold increases. |
| Databáze: | OpenAIRE |
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