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  • 1
    Electronic Resource
    Electronic Resource
    A Comparison of Two Stab-On Unipolar Epicardial Pacing Leads in Children (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The Oscor MP52V and Medtronic 4951 leads have similar construction and intended application. To determine if one of these designs was more suited to pediatric pacing, we reviewed implant, 3 month, and 12 months follow-up thresholds for all 18 MP52V implants at our institution from December 1989 to April 1991 and compared them to the 4951 implants from fanuary 1982 to October 1989. Lead suirival for tbe MP52V implants was compared to the most recent 36 4951 implants. Patients ranged in ages from 2 days–16 years (median = 4 years) and required antibradycardia pacing for congenital or acquired heart disease. Patients were compared for weigbt and proportion ofatrial leads in each group by t-test and Fisher exact tests respectively. Energy thresholds were assessed in μJ and compared by t-test. Lead survival was defined hy abandonment or replacement for any reason. Kaplan 8- Meier survival curves were plotted and compared by Gehan's Wilcoxan Test There were no significant differences between the MP52V and 4951 groups for age at implant (53 months vs 80 months) or proportion of atrial implants (5/18 vs 11/36). Lead survival was poor but did not differ significantly (70% vs 78% cumulative survival at 3 vears), usuallv failing by exit block. Implant and follow-up thresholds did not differ significantly between leads. The MP52V did not provide significant improvement in performance over the 4951. New epicardial lead designs are needed to improve lead survival and thresholds in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb03881.x
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  • 2
    Electronic Resource
    Electronic Resource
    Impact of Programmed Sensitivity Safety Factor on Atrial Sensing in Children (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The relationship between the pacemaker sensitivity safety factor (PSSF) and atrial under- or oversensing as documented by 24-hour Holter monitoring was examined. Our study comprised 78 transvenous fixed atrial leads implanted between 1983–1995 in 71 children. Overall, 210 Holter reports identified 143 (68%) Holters with normal atrial sensing function, 31 (15%) with undersensing, 32 (15%) with oversensing, and 4 (2%) with both problems. From 161 Holter reports in which the PSSF was available, the incidence of undersensing at a PSSF of 2.0 (range 1.5–2.4) was 25% (14/57). There was a dramatic decline in undersensing when the PSSF was 〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:01478389:PACE2163:ges" location="ges.gif"/〉 3 (3%) compared to a FSSF 〈 3 (21 %) (P 〈 0.001). A PSSF cut-off point of 2.0 best predicted occurrence of undersensing with a sensitivity of 79% and a specificity of 67%. Other variable were also examined by multiple logistic regression analysis, but only PSSF remained highly associated with undersensing (odds ratio [OR] = 0.6, P = 0.03). In contrast, PSSF did not have a significant role in predicting oversensing, but presence of sick sinus syndrome (OR = 10.5) or unipolar lead (OR = 5.6) were significantly associated with oversensing (P = 0.0001). The majority of undersensing problems can be avoided by routinely allowing for at least a threefold or more programmed sensitivity margin. Other factors may increase the risk of oversensing, regardless of the PSSF.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb04232.x
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  • 3
    Electronic Resource
    Electronic Resource
    Clinical Use of Permanent Pacemaker for Conversion of Intraatrial Reentry Tachycardia in Children (2001)
    Oxford, UK : Blackwell Futura Publishing, Inc.
    Pacing and clinical electrophysiology 24 (2001), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: CHIU, C.C., et al.: Clinical Use of Permanent Pacemaker for Conversion of Intraatrial Reentry Tachycardia in Children. The use of the implanted atrial-based pacemaker to overdrive postsurgical intraatrial reentry tachycardia (IART) was evaluated in a large group of pediatric patients over a 14-year study period. The authors sought to determine the feasibility of this noninvasive technique in the management of this specialized population and to determine factors associated with successful conversion. They examined 128 manual overdrive attempts performed on 22 consecutive patients. There were 10 patients with post-Fontan repair, 7 with post-Mustard/Senning procedure, and 5 with miscellaneous lesion types. The number of IART episodes for overdrive pacing per patient ranged from 1 to 15. The first overdrive pacing attempt was successful in 63% (14/22) of the patients. The mean IART cycle length was 278 ± 59 ms. The mean pacing rate for effective conversion of IART was 66 ± 10% faster than the IART rate. By controlling for repeated measures for individual patients, three factors were found to be independently associated with a successful outcome: (1) lesion type other than Fontan surgery (P = 0.007), (2) lack of acceleration of IART with the overdrive attempt (P 〈 0.001), and (3) patient use of amiodarone with attempt (P = 0.005). There were three procedural complications: two inadvertent overdrive pacing episodes, and one episode of acceleration of IART cycle length and conduction resulting in need for cardioversion. Manual pacemaker overdrive conversion of IART is a useful adjunct in the management of postsurgical IART in the pediatric population and should be considered as an initial treatment option.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1460-9592.2001.00950.x
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  • 4
    Electronic Resource
    Electronic Resource
    Risk Factors for Venous Obstruction in Children with Transvenous Pacing Leads (1997)
    Oxford, UK : Blackwell Publishing Ltd
    Pacing and clinical electrophysiology 20 (1997), S. 0 
    Details
    ISSN: 1540-8159
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: To determine tbe incidence and risk factors for venous obstruction in children with transvenous pacing leads, 63 children were evaluated clinically and echocardiographically. Patients with abnormal clinical and/or echocardiographic findings were further investigated by venography. Thirteen patients (21%) had evidence of venous obstruction. Venography in 11 (2 refused) showed that severity of obstruction (as defined by percentage of luminal narrowing) was complete (100%) in 3, severe (〉 90%) in 4. and moderate (60%-90%) in 5 (1 patient having 2 sites of obstruction). Risk factors for obstruction in 55 patients with single implantation procedures (10 with ohstruction: 18%) were sought. Total cross-sectional area of lead(s) was indexed to body surface area at implantation (INDEX). Patients with obstruction had a higher mean INDEX (7.6 ± 1.6 mm2/m2) than patients without obstruction (4.9 ± 2.0 mm2/m2); P 〈 0.0002). Receiver-operator characteristic curves showed an INDEX 〉 6.6 mm2/m2 to best predict obstruction, with a sensitivity of 90% and specificity of 84%. Since pacingis lifelong, sizing of transvenous leads to the child is important to prevent obstruction and preserve venous access.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1540-8159.1997.tb03594.x
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    Paper (German National Licenses)
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