Beaufort-Krol G C, Mulder H, Nagelkerke D, Waterbolk T W, Bink-Boelkens M T
Beatrix Children's Hospital, Division of Pediatric Cardiology, and Thoracic Center, University of Groningen, Groningen, The Netherlands.
J Thorac Cardiovasc Surg. 1999 Mar;117(3):523-8. doi: 10.1016/s0022-5223(99)70332-6.
Because of either cardiac anatomy or small size, pacing in children often occurs by means of epicardial leads. The disadvantage of epicardial leads is the shorter longevity of these leads compared with endocardial leads. During short-term follow-up, improved stimulation thresholds were found for the newer steroid-eluting epicardial leads. The longevity of these leads may be better than that of conventional epicardial leads. An improved longevity of epicardial leads may influence the choice to either epicardial or endocardial pacing in children.
We studied the longevity and the pacing and sensing characteristics of 33 steroid-eluting epicardial pacing leads (group I, 15 atrial, 18 ventricular) implanted between November 1991 and October 1996 in 20 children with a mean age of 7.6 +/- 6.5 years (mean +/- SD), and 29 endocardial pacing leads (group II, 15 atrial, 14 ventricular) implanted during the same period in 21 children with a mean age of 11.7 +/- 4.7 years.
The mean follow-up in group I was 2.9 +/- 1.6 years and in group II 3.1 +/- 1.7 years (P =.61). The 2-year survival of the leads in group I was 91% +/- 5% and in group II 86% +/- 7% (P =.97). Lead failure occurred in both groups in 4 leads (P =.85). Chronic stimulation and sensing thresholds were similar.
Steroid-eluting epicardial leads have the same longevity as the conventional endocardial leads. Pacing and sensing thresholds were similar and did not change during follow-up. Therefore steroid-eluting epicardial pacing leads are a good alternative for endocardial leads in small children and in children with congenital heart disease.
由于心脏解剖结构或患儿体型较小，儿童起搏常采用心外膜导线。心外膜导线的缺点是与心内膜导线相比，其使用寿命较短。在短期随访中，发现新型类固醇洗脱心外膜导线的刺激阈值有所改善。这些导线的使用寿命可能优于传统的心外膜导线。心外膜导线使用寿命的提高可能会影响儿童心外膜起搏或心内膜起搏方式的选择。
我们研究了1991年11月至1996年10月期间植入的33根类固醇洗脱心外膜起搏导线（I组，15根心房导线，18根心室导线）的使用寿命以及起搏和感知特性，这些导线植入了20名平均年龄为7.6±6.5岁（平均±标准差）的儿童体内；同时研究了同期植入的29根心内膜起搏导线（II组，15根心房导线，14根心室导线）的相关情况，这些导线植入了21名平均年龄为11.7±4.7岁的儿童体内。
I组的平均随访时间为2.9±1.6年，II组为3.1±1.7年（P = 0.61）。I组导线的2年生存率为91%±5%，II组为86%±7%（P = 0.97）。两组均有4根导线发生故障（P = 0.85）。慢性刺激和感知阈值相似。
类固醇洗脱心外膜导线的使用寿命与传统心内膜导线相同。起搏和感知阈值相似，且在随访期间没有变化。因此，对于小儿及先天性心脏病患儿，类固醇洗脱心外膜起搏导线是心内膜导线的良好替代选择。
