Heart Care Info - Heart Disease Prevention & Treatment

... ? Post operative performance of a novel left ventricular quadripolar electrode leadICD therapy in patients enlisted for heart transplantation between 2007-2010: a ...

M Biffi, D Exner, G Crossley, B Ramza... - ..., 2011 - Eur Heart Rhythm Assoc Results: The average follow up time for the combined cohort of 1307 study patients was 15 months; 169 (12.9%) experienced PNS symptoms. Overall, PNS related complications requiring invasive treatments to resolve symptoms occurred in 21/1307 patients (1.6%): 16/738 ...

Purpose: Venous thrombosis and stenosis remain one of the complications of endocardial pacemaker/AICD implantation. Their presence can result in difficulty in implanting leads. This study looks at the occurrence of venous abnormalities in children and whether routine pre-procedure angiography can be useful in identifying access issues prior to implantation. This is more significant in children due to the higher number of lead related procedures required both due to the longer pacing duration and the replacement of leads as a consequence of growth.

Methods: Patients under the age of 18 years undergoing pacemaker/AICD implantation and/or lead related procedures (lead change, advancement or removal) from 2001-2010 with pre-procedure angiography (3-7mls of contrast injected via a superficial vein in the ipsilateral arm) were selected. Patients with incomplete angiography history were excluded. Procedure details were collected from the unit database, hospital notes and digital angiography records.

Results: 51 children (out of 146) satisfied the inclusion criteria (70 procedures). Mean age at procedure was 9.58 years. The underlying diagnosis included: normal heart (65%), congenital heart defect (27%) and others (8%). The arrhythmia diagnosis included: complete heart block (congenital 37%, post operative 20%), resuscitated cardiac arrest/long QT (14%) and others (29%). Of the procedures performed, 11 (16%) had abnormal angiography pre-procedure. This included: venous stenosis (55%), occlusion (27%) and venous abnormality (18%). 3 angiograms were abnormal at first implantation. 2 of those 3 patients had cardiac surgery with intensive care stay. The remainder 8 abnormal angiographies were in patients who have a pacemaker/AICD in situ. 8 patients (19%) accounted for the angiogram abnormalities, including the 2 from intensive care. 15 (29%) of the patients had more than one angiography with a mean of 3.24 years between angiographies. Of those, 5 (33%) had an abnormal angiography subsequently. Of the abnormal angiographies, 4 procedures were altered as a result of knowing venous anatomy.

Conclusion: A small but important number of children have abnormal venous drainage which may affect pacemaker implantation. Although most occur as a consequence of previous pacemaker implantation, abnormalities may be present following venous line insertion in the intensive care unit or as a consequence of a congenital anomaly. Pre-pacing angiographies provide additional information which may be invaluable in highlighting abnormal venous anatomy to the operator and potentially altering the site and placement of leads.