Europace Advance Access published online on April 29, 2008
Europace, doi:10.1093/europace/eun109
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Patient- and lead-related factors affecting lead fracture in children with transvenous permanent pacemaker
1 Division of Pediatric Cardiology, Department of Pediatrics, Ataturk University, Erzurum, Turkey; 2 Division of Pediatric Cardiology, Department of Pediatrics, Hacettepe University, Ihsan Dogramaci Children Hospital, Sihhiye, Ankara, Turkey
Aims: Fracture in transvenous pacing leads is one of the most common reasons for lead abandonment. Although the factors affecting lead failure rates have been investigated, there is no study evaluating the clinical parameters that affect lead fracture in children. We report our experience with lead fracture in children with transvenous pacemakers.
Methods and results: The follow-up results of 264 leads from 184 patients were evaluated using pacemaker follow-up data. Underlying conditions, implant data, and lead features were evaluated for the analysis of lead fracture. During a mean follow-up of 72.8 ± 39.7 months (range 3.2–160.6, median 70), lead fracture developed in 19 leads (7.2%) from 18 patients. The mean duration between implantation and lead fracture was 57.3 ± 35 months (range 6.8–130, median 51). All fractures occurred in the leads implanted by the infraclavicular subclavian approach. Cumulative survival at the end of 5 years was 92.7% in terms of lead fracture. None of the patient-related risk factors correlated with lead fracture. Multivariate analyses of lead-related risk factors revealed a significant correlation only between lead fracture and fixation mechanism (P < 0.05).
Conclusion: Our results indicated that none of the patient-related risk factors was correlated with lead fracture. Among lead-related risk factors, only the fixation mechanism was found to be correlated with lead fracture; thus, it seems that passive fixation mechanism is safer in terms of lead fracture. Although all fractures occurred in the leads implanted by the intrathoracic subclavian approach, statistical analysis revealed no significance for this parameter. The effect of the extrathoracic approach should be investigated in a large group of patients.
Key Words: Children, Endocardial, Lead fracture, Pacemaker, Transvenous
* Corresponding author. Tel: +90 312 3051157; fax: +90 312 3090220. E-mail address: alpayceliker{at}gmail.com; aceliker{at}hacettepe.edu.tr
Manuscript submitted 11 January 2008. Accepted after revision 7 April 2008.