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389 ENDOCARDIAL VERSUS EPICARDIAL PERMANENT PACING IN CHILDREN
  1. B. Suckow,
  2. J. Odim,
  3. H. Laks,
  4. B. Saedi,
  5. K. Shannon
  1. Los Angeles, CA.

Abstract

Background Children requiring permanent pacing have a lifelong need for follow-up and re-intervention. Epicardial leads have traditionally fared worse than endocardial counterparts. We sought to test the hypothesis that steroid-eluting epicardial and endocardial leads had equivalent outcomes.

Methods We reviewed the medical records of 160 children, mean age 7.4 ± 5.5 yrs (range, 0.4 to 18 yrs), in whom a pacemaker system with steroid-eluting leads from a single manufacturer was implanted. Primary outcomes were early and late mortality. Secondary outcomes included freedom from lead failure and pacemaker system re-intervention. Loss of capture/sensing, lead displacement/fracture, exit block and high thresholds constituted lead failure. Re-intervention included the need for lead revision or generator change.

Results There was no early mortality. Late mortality occurred once (0.5 ± 0.5 deaths/1000 pt.-mos) and 8 times (3.4 ± 1.2 deaths/1000 pt.-mos) in the endocardial and epicardial groups, respectively. The relative hazard of endocardial vs. epicardial site for lead failure was 0.408 (p=0.038) and for re-intervention was 0.629 (p=0.002). Endocardial and epicardial groups differed in important ways: concomitant cardiac surgery 5% (3/61) vs. 27% (27/99), congenital heart disease 33% (20/61) vs. 90% (89/99), single ventricle physiology 13% (8/61) vs. 52% (51/99), and age (10.5 ± 4.5 yrs. vs. 5.5±± 5.2 yrs.). Adjusting for these co-variants by a proportional hazards (Cox) model, the relative hazard for freedom from lead failure for endocardial vs. epicardial leads was 0.546 (p=0.360). The adjusted relative hazard for freedom from re-intervention was 0.157 (p=0.045).

Conclusions Present technological advances render no important differences in lead failure rates between endocardial and epicardial steroid-eluting pacing leads in children thus bridging the performance gap between these fixation sites.

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