Long-term atrial and ventricular epicardial pacemaker lead survival after cardiac operations in pediatric patients with congenital heart disease

BackgroundMultiple cardiac operations and resultant myocardial scarring have been implicated in the overall reduced performance of epicardial pacing systems in patients with congenital heart disease (CHD).ObjectiveThe aim of the study is to evaluate long-term permanent epicardial pacing lead survival in patients with CHD who had epicardial lead placement in association with surgical repair or palliation.MethodsA retrospective review of patients who had implantation of epicardial pacing systems between January 1984 and June 2010 was conducted. Inclusion criteria were as follows: (1) presence of CHD and (2) cardiac operation(s) concomitant with or before initial permanent epicardial lead implantation. Patients were divided into 2 anatomical groups: single ventricle (SV) and biventricle (Bi-V).ResultsEpicardial leads were implanted in 663 patients during the study period. One hundred fifty-five patients (76 SV [49%] and 79 Bi-V [51%]) were included, resulting in 259 leads and 946 lead-years of follow-up. There were 2 deaths and 8 infections attributable to pacemaker placement. Overall atrial lead survival at 1, 2, 5, and 10 years (99%, 93%, 83%, and 72%) was comparable with ventricular lead survival (97%, 90%, 74%, and 60%) (P = .540) and was also similar between SV and Bi-V patients. Cox regression analysis demonstrated that SV palliation and an earlier era of lead implantation (1984–1999) was significantly associated with ventricular, but not atrial, lead malfunction.ConclusionEpicardial leads had acceptable longevity despite cardiac operations for complex CHD, suggesting the long-term reliability of this pacing method.