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- Title
Epicardial versus endocardial permanent pacing in adults with congenital heart disease.
- Authors
McLeod, Christopher John; Jost, Christine H.; Warnes, Carole A.; Hodge II, David; Hyberger, Linda; Connolly, Heidi M.; Asirvatham, Samuel J.; Dearani, Joseph A.; Hayes, David L.; Ammash, Naser M.
- Abstract
Background: Permanent pacing (PM) in patients with congenital heart disease (CHD) presents unique challenges-with little known about the long-term outcomes. Methods: Pacemaker complications and reinterventions were reviewed over a 38-year period and were grouped by epicardial or endocardial approaches. Results: The average age at intervention was 37 ± 19 years for 106 patients and 259 PM procedures were performed (2.4 ± 2 per patient). From the first PM procedure, patients were followed for 11.6 ± 14 years. The most common indications for initial PM intervention were heart block (25%) and sinus node dysfunction (20%), yet reintervention was driven primarily by lead failure (49%). Endocardial systems were initially implanted in 73 patients (67%). Epicardial pacing was more common in patients with complex CHD ( p = 0.006), cyanosis ( p < 0.001), residual shunts (0.01), or Ebstein's anomaly ( p = 0.01). Fifty-one devices (28%) developed lead or generator complications. Epicardial systems were most likely to develop lead failure ( p < 0.0001), predominantly in the ventricular lead ( p < 0.0001). Endocardial systems were found to be more durable than the epicardial systems ( p = 0.023), and Ebstein's anomaly or an epicardial system was an independent predictor of lead failure. Conclusions: Permanent pacing in CHD is associated with considerable morbidity and the need for repeat intervention, especially in those with Ebstein's anomaly. Epicardial pacing systems appear to have a higher incidence of lead failure and are significantly less durable in this group.
- Subjects
CONGENITAL heart disease; HEALTH outcome assessment; ENDOCARDIUM; ENDOCARDIAL cushion defects; HEART block; SINOATRIAL node; PATIENTS
- Publication
Journal of Interventional Cardiac Electrophysiology, 2010, Vol 28, Issue 3, p235
- ISSN
1383-875X
- Publication type
Article
- DOI
10.1007/s10840-010-9494-4