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

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.