Objective : In a paediatric population we studied the feasibility and mid term results of epicardial pacing with automatic threshold tracking and output adjustment (autocapture) in combination with steroid-eluting leads.
Methods : In 15 children of median age 130 days (5 days-15 years) and median weight 5,2 kg (2,9 - 36 kg) an autocapture (AC) pacing device (Pacesetter Microny SR+) and a bipolar steroid-eluting epicardial lead (Medtronic CapSure EPI) was implanted for complete AV block (4 congenital , 11 in conjunction with or after surgery for congenital heart disease ), through subxyphoidal access with the battery in the rectus sheath. Impedance (R),voltage threshold (T), evoked response (ER) and polarisation signals (P) were measured at implantation and 6-monthly. The AC feature was applied if the proposed ER/P ratio was above 1,6.
Results : Complete follow-up was available up to 6 years after the first implant, with a median follow-up 31 months (1 - 69 months). Three children died during the study. Pacing and sensing characteristics remained stable over the study period, with an AC programmation in 80% of the patients (table).
Conclusions : Epicardial pacing with threshold tracking and output adjustment, combined with steroid-eluting leads results in stable pacing and sensing characteristics. A favourable ER/P ratio allows autocapture function use in the majority of children with complete AV block, thus narrowing the gap between transvenous and epicardial pacing in the paediatric population.
|
Implant |
6 months |
12 months |
18 months |
24 months |
p-value | |
| R (Ohm) |
629 + 95 |
582 + 98 |
567 + 99 |
578 + 126 |
557 + 57 |
NS |
| T (Volt) |
0,8 + 0,25 |
0,7 + 0,3 |
0,9 + 0,3 |
0,8 + 0,3 |
0,9 + 0,5 |
NS |
| ER (mV) |
9,6 + 6 |
8,5 + 4 |
9,6 + 7 |
9,6 + 8 |
10 + 8 |
NS |
| P (mV) |
1,4 + 0,9 |
1,2 + 0,4 |
1,1 + 0,3 |
1,1 + 0,3 |
0,9 + 0,1 |
NS |
| AC (%) |
67 % |
73 % |
90 % |
86 % |
80 % |
NS |