Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approach with excellent functional and cosmetic results.

Détails

ID Serval
serval:BIB_E322A51E6026
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approach with excellent functional and cosmetic results.
Périodique
European Journal of Cardio-thoracic Surgery
Auteur(s)
Dodge-Khatami A., Kadner A., Dave H., Rahn M., Prêtre R., Bauersfeld U.
ISSN
1010-7940 (Print)
ISSN-L
1010-7940
Statut éditorial
Publié
Date de publication
2005
Peer-reviewed
Oui
Volume
28
Numéro
4
Pages
541-545
Langue
anglais
Résumé
OBJECTIVE: Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy is an alternative approach for lead insertion in children, avoiding venous access complications and right ventricular stimulation, without compromising sporting or musical activities. We analyzed the survival and performance of left atrial and left ventricular epicardial pacing leads, and present mid-term follow-up data.
METHODS: Seventy-five bipolar steroid eluting pacing leads (Medtronic CapSure Epi 4968) were implanted in 41 children, aged 8.6+5.1 years. Pacing systems included 34 DDDR and 7 VVIR. Pacing leads were inserted through a muscle-sparing left lateral thoracotomy, and sutured to the left atrial appendage or atrium, and to the left ventricle. The generators were buried behind the abdominal muscles or between the thoracic muscle layers. Congenital heart disease with previous cardiac surgery was present in 25 children. Indications for pacing were post-operative heart block (n=14), sinus node disease (n=13), congenital heart block (n=9), and various (n=5). Threshold values and measured data were obtained at 6-month intervals. The mean follow-up was 3.8+2.9 years.
RESULTS: There was no mortality or major morbidity, with excellent functional and cosmetic results. Lead survival was 94 and 86% for atrial leads, and 97 and 86% for ventricular leads, at 1 and 5 years, respectively. There were five reoperations for lead fracture (n=2), insulation break (n=1), oversensing (n=1), and infection (n=1). Device reprogramming was required in three instances. In the absence of acute lead failure, mid-term follow-up shows very satisfactory and stable lead performance.
CONCLUSIONS: Left heart atrial and ventricular epicardial pacing leads inserted through a left lateral thoracotomy demonstrate a high probability of survival, with favorable pacing characteristics, and optimal sensing thresholds at mid-term follow-up. Epicardial left heart pacing is reliable, and easy access can be achieved through a cosmetic and functional muscle-sparing left lateral thoracotomy.
Pubmed
Web of science
Open Access
Oui
Création de la notice
16/12/2014 17:41
Dernière modification de la notice
20/08/2019 16:06
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