Abstract 18656: A Decade of Follow-up with Excellent Transmural Atrial Lead Performance in Complex Congenital Heart Patients
Background: Many patients (pts) with postoperative congenital heart disease require permanent pacing for rhythm management and cannot undergo transvenous atrial leads. Extensive epicardial scar can prohibit adequate acute and chronic pacing and sensing thresholds. We described transmural atrial lead (TMA, epicardial to endocardial) pacing previously and now report long-term lead performance.
Methods: A bipolar, steroid eluting transvenous lead is placed from the epicardial surface via purse-string and affixed to position the lead against the atrial endocardium. 52 patients underwent TMA placement between 1998 and 2004. Records were reviewed for lead characteristics and acute and long term performance. Follow up data was available for 51 patients. TMAs were placed in the right atrial appendage, the lateral right atrial wall, left atrium, and dome of the left atrium. Medtronic 5072 (n=43), Guidant 4469 (n=6) or other (n=3) leads were used.
Results: 52 pts underwent TMA at an avg age of 13.4 yrs; 19 to replace existing leads and 36 as part of a larger surgery. Pre-op, 25 pts had atrial tachycardia (AT). 22 pts had Fontan/revision. Acute TMA pace threshold was 0.87V @ 0.5msec. 43/52 leads remain active at an avg follow-up of 10.2 yrs. Chronic pace threshold avg is 0.96V @ 0.3-0.5msec; atrial electrogram is 2.97mV in 30/43 pts with intrinsic P waves. Atrial overdrive of AT using TMA was successful in 8/9 pts. No clots were oberved in any pt in follow-up. 3 pts died (one awaiting transplant, one sudden, one stroke (TMA on Fontan side, no fenestration). There were 2 TMA fractures, 3 removed for non-TMA reasons.
Conclusions: TMAs show excellent late functional properties as an alternative to epicardial leads in complex pts, maintaining low atrial pacing thresholds, consistent sensing and the benefit of effective overdrive pacing of ATs. TMAs exhibit superior long term performance in complex Fontan and atrial switch patients.
- © 2012 by American Heart Association, Inc.