Epicardial versus endocardial permanent pacing in adults with congenital heart disease
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Permanent pacing (PM) in patients with congenital heart disease (CHD) presents unique challenges—with little known about the long-term outcomes.
Pacemaker complications and reinterventions were reviewed over a 38-year period and were grouped by epicardial or endocardial approaches.
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.
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.
- Brickner, M. E., Hillis, L. D., & Lange, R. A. (2000). Congenital heart disease in adults. First of two parts. The New England Journal of Medicine, 342, 256–263. CrossRef
- Walker, F., Siu, S. C., Woods, S., et al. (2004). Long-term outcomes of cardiac pacing in adults with congenital heart disease. Journal of the American College of Cardiology, 43, 1894–1901. CrossRef
- Cohen, M. I., Bush, D. M., Vetter, V. L., et al. (2001). Permanent epicardial pacing in pediatric patients: Seventeen years of experience and 1200 outpatient visits. Circulation, 103, 2585–2590.
- Batra, A. S., & Balaji, S. (2006). Pacing in adults with congenital heart disease. Expert Review of Cardiovascular Therapy, 4, 663–670. CrossRef
- Berul, C. I., & Cecchin, F. (2003). Indications and techniques of pediatric cardiac pacing. Expert Review of Cardiovascular Therapy, 1, 165–176. CrossRef
- Khairy, P., Landzberg, M. J., Gatzoulis, M. A., et al. (2006). Transvenous pacing leads and systemic thromboemboli in patients with intracardiac shunts: A multicenter study. Circulation, 113, 2391–2397. CrossRef
- Sachweh, J. S., Vazquez-Jimenez, J. F., Schondube, F. A., et al. (2000). Twenty years experience with pediatric pacing: Epicardial and transvenous stimulation. European Journal of Cardiothoracic Surgery, 17, 455–461. CrossRef
- Warnes, C. A., Liberthson, R., Danielson, G. K., et al. (2001). Task force 1: The changing profile of congenital heart disease in adult life. Journal of the American College of Cardiology, 37, 1170–1175. CrossRef
- Paul, T. B. A., & Saul, J. (2003). Invasive electrophysiology and pacing. In: M. A. Gatzoulis, G. D. Webb, & P. E. F. Daubeney (Eds.), Diagnosis and management of adult congenital heart disease (517 p). Edinburgh: Churchill Livingstone; xi.
- Allen, M. R., Hayes, D. L., Warnes, C. A., & Danielson, G. K. (1997). Permanent pacing in Ebstein's anomaly. Pacing and Clinical Electrophysiology, 20, 1243–1246. CrossRef
- Balmer, C., Fasnacht, M., Rahn, M., Molinari, L., & Bauersfeld, U. (2002). Long-term follow up of children with congenital complete atrioventricular block and the impact of pacemaker therapy. Europace, 4, 345–349. CrossRef
- Wiegand, U. K., Bode, F., Bonnemeier, H., et al. (2003). Long-term complication rates in ventricular, single lead VDD, and dual chamber pacing. Pacing and Clinical Electrophysiology, 26, 1961–1969. CrossRef
- Eberhardt, F., Bode, F., Bonnemeier, H., et al. (2005). Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity. Heart, 91, 500–506. CrossRef
- Esperer, H. D., Singer, H., Riede, F. T., et al. (1993). Permanent epicardial and transvenous single- and dual-chamber cardiac pacing in children. Thoracic and Cardiovascular Surgeon, 41, 21–27. CrossRef
- Trohman, R. G., Kim, M. H., & Pinski, S. L. (2004). Cardiac pacing: The state of the art. Lancet, 364, 1701–1719. CrossRef
- Fortescue, E. B., Berul, C. I., Cecchin, F., et al. (2004). Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm, 1, 150–159. CrossRef
- Noiseux, N., Khairy, P., Fournier, A., & Vobecky, S. J. (2004). Thirty years of experience with epicardial pacing in children. Cardiology in the Young, 14, 512–519. CrossRef
- Weindling, S. N., Saul, J. P., Gamble, W. J., et al. (1998). Duration of complete atrioventricular block after congenital heart disease surgery. The American Journal of Cardiology, 82, 525–527. CrossRef
- Gross, G. J., Chiu, C. C., Hamilton, R. M., Kirsh, J. A., & Stephenson, E. A. (2006). Natural history of postoperative heart block in congenital heart disease: Implications for pacing intervention. Heart Rhythm, 3, 601–604. CrossRef
- Daliento, L., Angelini, A., Ho, S. Y., et al. (1997). Angiographic and morphologic features of the left ventricle in Ebstein's malformation. The American Journal of Cardiology, 80, 1051–1059. CrossRef
- Celermajer, D. S., Dodd, S. M., Greenwald, S. E., Wyse, R. K., & Deanfield, J. E. (1992). Morbid anatomy in neonates with Ebstein's anomaly of the tricuspid valve: Pathophysiologic and clinical implications. Journal of the American College of Cardiology, 19, 1049–1053. CrossRef
- Saxena, A., Lee, A. H., & Fong, L. V. (1993). Functional and histological abnormalities of the left ventricle in Ebstein's anomaly of the tricuspid valve. Indian Heart Journal, 45, 135–136.
- Glikson, M., von Feldt, L. K., Suman, V. J., & Hayes, D. L. (1994). Clinical surveillance of an active fixation, bipolar, polyurethane insulated pacing lead, Part I: The atrial lead. Pacing and Clinical Electrophysiology, 17, 1399–1404. CrossRef
- Beaufort-Krol, G. C., Mulder, H., Nagelkerke, D., Waterbolk, T. W., & Bink-Boelkens, M. T. (1999). Comparison of longevity, pacing, and sensing characteristics of steroid-eluting epicardial versus conventional endocardial pacing leads in children. The Journal of Thoracic and Cardiovascular Surgery, 117, 523–528. CrossRef
- Epicardial versus endocardial permanent pacing in adults with congenital heart disease
Journal of Interventional Cardiac Electrophysiology
Volume 28, Issue 3 , pp 235-243
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Epicardial pacing
- Congenital heart disease
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- Author Affiliations
- 1. Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- 3. Division of Biostatistics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- 2. Division of Cardiovascular Operation, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA