Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease

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Abstract

AimsAtrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients.Methods and resultsWe evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P<0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41, atrioventricular septal defect 11, tetralogy 9, ventricular septal defect 8), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50), atrioventricular block (38), cardiomyopathies, and primary ventricular arrhythmias (12). Leads are steroid-eluting (98), tined (59), screw-in (41), polyurethane-insulated (72), silicone-insulated (28), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50), right atrial free wall/septum (25), left atrium (s/p Mustard, 25). Follow-up duration is 6.4 ± 4.8 (range 0.118) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5) (P 0.03); 16 leads (14) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P 0.03) positioned outside RAA (P 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P<0.001), impedance showed a decrease (0.6 Ω/month, P<0.001), P-wave showed no significant difference.ConclusionsTransvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period. Published on behalf of the European Society of Cardiology. All rights reserved.

Original languageEnglish
Pages (from-to)1002-1007
Number of pages6
JournalEuropace
Volume14
Issue number7
DOIs
Publication statusPublished - Jul 2012

Fingerprint

Young Adult
Heart Diseases
Mustard Plant
Sick Sinus Syndrome
Subclavian Vein
Atrial Appendage
Transposition of Great Vessels
Polyurethanes
Congenital Heart Defects
Atrioventricular Block
Ventricular Heart Septal Defects
Silicones
Heart Atria
Electric Impedance
Cardiomyopathies
Punctures
Cardiac Arrhythmias
Multivariate Analysis
Steroids
Pediatrics

Keywords

  • Cardiac pacing
  • Children
  • Endocardial pacing
  • Pacemaker
  • Pacing complications
  • Pacing leads

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{ee16a2e9cc2741ae842109465d983815,
title = "Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease",
abstract = "AimsAtrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients.Methods and resultsWe evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P<0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41, atrioventricular septal defect 11, tetralogy 9, ventricular septal defect 8), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50), atrioventricular block (38), cardiomyopathies, and primary ventricular arrhythmias (12). Leads are steroid-eluting (98), tined (59), screw-in (41), polyurethane-insulated (72), silicone-insulated (28), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50), right atrial free wall/septum (25), left atrium (s/p Mustard, 25). Follow-up duration is 6.4 ± 4.8 (range 0.118) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5) (P 0.03); 16 leads (14) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P 0.03) positioned outside RAA (P 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P<0.001), impedance showed a decrease (0.6 Ω/month, P<0.001), P-wave showed no significant difference.ConclusionsTransvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period. Published on behalf of the European Society of Cardiology. All rights reserved.",
keywords = "Cardiac pacing, Children, Endocardial pacing, Pacemaker, Pacing complications, Pacing leads",
author = "Silvetti, {Massimo Stefano} and Fabrizio Drago and Lucilla Rav",
year = "2012",
month = "7",
doi = "10.1093/europace/eus024",
language = "English",
volume = "14",
pages = "1002--1007",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease

AU - Silvetti, Massimo Stefano

AU - Drago, Fabrizio

AU - Rav, Lucilla

PY - 2012/7

Y1 - 2012/7

N2 - AimsAtrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients.Methods and resultsWe evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P<0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41, atrioventricular septal defect 11, tetralogy 9, ventricular septal defect 8), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50), atrioventricular block (38), cardiomyopathies, and primary ventricular arrhythmias (12). Leads are steroid-eluting (98), tined (59), screw-in (41), polyurethane-insulated (72), silicone-insulated (28), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50), right atrial free wall/septum (25), left atrium (s/p Mustard, 25). Follow-up duration is 6.4 ± 4.8 (range 0.118) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5) (P 0.03); 16 leads (14) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P 0.03) positioned outside RAA (P 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P<0.001), impedance showed a decrease (0.6 Ω/month, P<0.001), P-wave showed no significant difference.ConclusionsTransvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period. Published on behalf of the European Society of Cardiology. All rights reserved.

AB - AimsAtrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients.Methods and resultsWe evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P<0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41, atrioventricular septal defect 11, tetralogy 9, ventricular septal defect 8), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50), atrioventricular block (38), cardiomyopathies, and primary ventricular arrhythmias (12). Leads are steroid-eluting (98), tined (59), screw-in (41), polyurethane-insulated (72), silicone-insulated (28), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50), right atrial free wall/septum (25), left atrium (s/p Mustard, 25). Follow-up duration is 6.4 ± 4.8 (range 0.118) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5) (P 0.03); 16 leads (14) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P 0.03) positioned outside RAA (P 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P<0.001), impedance showed a decrease (0.6 Ω/month, P<0.001), P-wave showed no significant difference.ConclusionsTransvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period. Published on behalf of the European Society of Cardiology. All rights reserved.

KW - Cardiac pacing

KW - Children

KW - Endocardial pacing

KW - Pacemaker

KW - Pacing complications

KW - Pacing leads

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U2 - 10.1093/europace/eus024

DO - 10.1093/europace/eus024

M3 - Article

C2 - 22379180

AN - SCOPUS:84863005713

VL - 14

SP - 1002

EP - 1007

JO - Europace

JF - Europace

SN - 1099-5129

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