Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

Abstract

Background: Multiple cardiac operations and resultant myocardial scarring have been implicated in the overall reduced performance of epicardial pacing systems in patients with congenital heart disease (CHD).

Objective: The aim of the study is to evaluate long-term permanent epicardial pacing lead survival in patients with CHD who had epicardial lead placement in association with surgical repair or palliation.

Methods: A retrospective review of patients who had implantation of epicardial pacing systems between January 1984 and June 2010 was conducted. Inclusion criteria were as follows: (1) presence of CHD and (2) cardiac operation(s) concomitant with or before initial permanent epicardial lead implantation. Patients were divided into 2 anatomical groups: single ventricle (SV) and biventricle (Bi-V).

Results: Epicardial leads were implanted in 663 patients during the study period. One hundred fifty-five patients (76 SV [49%] and 79 Bi-V [51%]) were included, resulting in 259 leads and 946 lead-years of follow-up. There were 2 deaths and 8 infections attributable to pacemaker placement. Overall atrial lead survival at 1, 2, 5, and 10 years (99%, 93%, 83%, and 72%) was comparable with ventricular lead survival (97%, 90%, 74%, and 60%) (P = .540) and was also similar between SV and Bi-V patients. Cox regression analysis demonstrated that SV palliation and an earlier era of lead implantation (1984-1999) was significantly associated with ventricular, but not atrial, lead malfunction.

Conclusion: Epicardial leads had acceptable longevity despite cardiac operations for complex CHD, suggesting the long-term reliability of this pacing method.

Keywords: Congenital heart disease; Fontan procedure; Pacing; Pediatrics.