Lateral thoracotomy for epicardial pacemaker placement in patients with congenital heart disease.

Abstract:

OBJECTIVES:Our institution adopted a lateral thoracotomy approach to epicaridal pacemaker implantation with the objective of avoiding epicardial scar tissue and to achieve adequate lead pacing and sensing. We sought to assess the short-term outcomes of this approach. METHODS:A single-centre review was conducted in paediatric patients and adults with congenital heart disease or inherited arrhythmia syndromes who underwent a lateral thoracotomy for epicardial pacemaker placement from August 2010 to January 2016. Patient histories were recorded along with outcomes including complications, lead and generator performance. RESULTS:Twenty-one operations were performed in 20 patients (median age 17 years, range 3 months-49 years), including 19 pacemakers and 2 implantable-cardioverter defibrillators (ICDs). Prior epicardial pacemakers had been placed in 11 (55%) patients, including 3 with multiple pacemakers. Most patients had undergone at least 1 prior cardiac operation, with a mean of 3.2 (range 0-7) prior cardiac operations. Through our lateral thoracotomy approach, 17 of the 19 attempted atrial leads (89%) and 20 of the 20 attempted ventricular leads (100%) were successfully implanted with acceptable pacing thresholds. Complications included 1 (5%) bleeding, 2 (10%) pacemaker pocket revisions and 1 late death at 6 months unrelated to the pacemaker. There were no lead failures at a mean follow-up period of 27.5 months (range of 0.7-56.1 months). CONCLUSIONS:The lateral thoracotomy is a useful approach for epicardial pacemaker implantation in patients with congenital heart disease or inherited arrhythmia syndromes including those with multiple prior operations.

authors

Haight PJ,Stewart RE,Saarel EV,Pettersson GB,Najm HK,Aziz PF

doi

10.1093/icvts/ivx379

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

845-851

issue

5

eissn

1569-9293

issn

1569-9285

pii

4782501

journal_volume

26

pub_type

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