Europace Advance Access published online on July 13, 2007
Europace, doi:10.1093/europace/eum130
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Long-term experience with AutoCapture®-controlled epicardial pacing in children
1 Division of Pediatric Cardiology, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, Switzerland; 2 Biostatistics Unit, University Zurich, Switzerland; 3 Division of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
Aims To examine the feasibility and safety of AutoCapture (AC)-controlled pacing with epicardial leads in children, and study the effects on device longevity.
Methods A total of 62 children were prospectively enrolled. Pre-discharge testing precluded AC function in six children. In 56 (90%) children, devices with AC-controlled pacing were followed up to 9 years. Calculated battery life in AC-controlled pacing was compared with theoretical calculations, using a two-fold stimulation output of measured thresholds.
Results In 53 of 56 children, no differences were observed for evoked response signals (13.3 vs. 11.5 mV, P=0.20) or lead polarization safety margins (5.5 vs. 4.1, P=0.25) at 6-month and 4-year follow-up. A crossover to conventional pacing was required in 3 of 56 children. AC-controlled pacing prolonged the calculated battery life up to 15% for the identity and integrity devices with 0.95 A h capacity, compared with theoretical conventional settings (P=0.008). In patients with ventricular pacing thresholds >1.5 V at 0.5 ms, battery life was increased by 30% compared with theoretical conventional settings (P<0.001).
Conclusion AC-controlled pacing with epicardial leads is feasible and safe in children during long-term follow-up. An adequate lead polarization safety margin persists in most patients. Calculated battery life was prolonged up to 15% with AC-controlled pacing. Patients with high or fluctuating pacing thresholds benefit the most.
Key Words: Pacemaker, AutoCapture, Safety, Battery service life, Epicardial pacing leads, Pediatric
* Corresponding author. Tel: +41 44 2667747; fax: +41 44 2667981. E-mail address: maren.tomaske{at}kispi.uzh.ch
Manuscript submitted 16 April 2007.
Revision received 11 June 2007.
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