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An epicardial pacing safety net: an alternative technique for pacing in the young

Published online by Cambridge University Press:  10 March 2009

Scott R. Ceresnak ,
Leonardo Liberman ,
Jonathan M. Chen ,
Allan J. Hordof ,
John J. Lamberti ,
William J. Bonney  and
Robert H. Pass
Scott R. Ceresnak*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, The Children’s Hospital of New York, New York Presbyterian Hospital – Columbia University, New York, New York, United States of America
Leonardo Liberman
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, The Children’s Hospital of New York, New York Presbyterian Hospital – Columbia University, New York, New York, United States of America
Jonathan M. Chen
Affiliation:
Department of Cardiothoracic Surgery, Morgan Stanley Children’s Hospital, The Children’s Hospital of New York, New York Presbyterian Hospital – Weill Cornell Medical Center, New York, United States of America
Allan J. Hordof
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, The Children’s Hospital of New York, New York Presbyterian Hospital – Columbia University, New York, New York, United States of America
John J. Lamberti
Affiliation:
Department of Cardiothoracic Surgery, Rady Children’s Hospital, The Children’s Hospital of San Diego, San Diego, California, United States of America
William J. Bonney
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, The Children’s Hospital of New York, New York Presbyterian Hospital – Columbia University, New York, New York, United States of America
Robert H. Pass
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Children’s Hospital at Montefiore, University Hospital of Albert Einstein College of Medicine, Bronx, New York, United States of America
*
Correspondence to: Scott R. Ceresnak, MD, Department of Pediatrics, Division of Pediatric Cardiology, Lucille Packard Children’s Hospital, Stanford University, 750 Welch Road, Suite #305, Palo Alto, CA 94304USA. Tel: (732) 233 – 8968; Fax: (866) 4593443; E-mail: ceresnak@yahoo.com
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Abstract

Epicardial pacing is the standard approach for permanent pacing in small children and patients with functionally univentricular physiology. The longevity of epicardial leads, however, is compromised by increased occurrences of exit block and lead fractures. We report our experience with a technique of placing a second ventricular lead, and attaching it to the atrial port of a dual chamber pacemaker to prevent the need for early re-operation in the event of failure of the primary epicardial lead. A retrospective review showed that, over the period from 2001 through 2007, epicardial ventricular pacemakers had been placed in 88 patients. In 6 of these, we had placed 2 ventricular leads, their median weight being 8.0 kilograms, with a range from 4.2 to 31.8 kilograms. Fracture of a lead occurred in 1 of the patients (17%) 8 months after placement, requiring reprogramming to pace from the atrial port. This possibility avoided the need for repeated emergent surgery. At a median follow-up of 1.5 years, with a range from 0.3 to 4.4 years, there have been no complications. During the same time period, overall failure of epicardial leads at our institution was 13%. Placement of a second ventricular epicardial pacing lead, attached to the atrial port of a dual chamber pacemaker, therefore, may provide a safe and effective means of ventricular pacing in the setting of epicardial lead failure, and may obviate the need for repeat, potentially urgent, pacemaker surgery.

Keywords

Pacemakerpaediatricsarrhythmia
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 3 , June 2009 , pp. 228 - 232
Copyright
Copyright © Cambridge University Press 2009

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