Dual-chamber epicardial pacing in neonates with congenital heart block

Angela Kelle, Carl L. Backer, Sabrina Tsao, Robert D. Stewart, Wayne H. Franklin, Barbara J. Deal, Constantine Mavroudis

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block. Methods: From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 ± 5.6 days and 2.8 ± 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets. Results: Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 ± 2.6 mV and atrial voltage threshold was 0.8 ± 0.3 V. Mean R-wave sensing was 13.0 ± 5.7 mV and ventricular voltage threshold 0.9 ± 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 ± 7.1 years with 1 patient lost to follow-up. Conclusions: Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.

Original languageEnglish (US)
Pages (from-to)1188-1192
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume134
Issue number5
DOIs
StatePublished - Nov 1 2007

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Newborn Infant
Heterotaxy Syndrome
Myocarditis
Cardiomyopathies
Congenital heart block
Hydrops Fetalis
Sternotomy
Lost to Follow-Up
Survivors
Steroids
Weights and Measures
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kelle, A., Backer, C. L., Tsao, S., Stewart, R. D., Franklin, W. H., Deal, B. J., & Mavroudis, C. (2007). Dual-chamber epicardial pacing in neonates with congenital heart block. Journal of Thoracic and Cardiovascular Surgery, 134(5), 1188-1192. https://doi.org/10.1016/j.jtcvs.2007.04.049
Kelle, Angela ; Backer, Carl L. ; Tsao, Sabrina ; Stewart, Robert D. ; Franklin, Wayne H. ; Deal, Barbara J. ; Mavroudis, Constantine. / Dual-chamber epicardial pacing in neonates with congenital heart block. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 134, No. 5. pp. 1188-1192.
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Kelle, A, Backer, CL, Tsao, S, Stewart, RD, Franklin, WH, Deal, BJ & Mavroudis, C 2007, 'Dual-chamber epicardial pacing in neonates with congenital heart block', Journal of Thoracic and Cardiovascular Surgery, vol. 134, no. 5, pp. 1188-1192. https://doi.org/10.1016/j.jtcvs.2007.04.049

Dual-chamber epicardial pacing in neonates with congenital heart block. / Kelle, Angela; Backer, Carl L.; Tsao, Sabrina; Stewart, Robert D.; Franklin, Wayne H.; Deal, Barbara J.; Mavroudis, Constantine.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 134, No. 5, 01.11.2007, p. 1188-1192.

Research output: Contribution to journalArticle

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T1 - Dual-chamber epicardial pacing in neonates with congenital heart block

AU - Kelle, Angela

AU - Backer, Carl L.

AU - Tsao, Sabrina

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AU - Deal, Barbara J.

AU - Mavroudis, Constantine

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N2 - Objective: This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block. Methods: From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 ± 5.6 days and 2.8 ± 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets. Results: Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 ± 2.6 mV and atrial voltage threshold was 0.8 ± 0.3 V. Mean R-wave sensing was 13.0 ± 5.7 mV and ventricular voltage threshold 0.9 ± 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 ± 7.1 years with 1 patient lost to follow-up. Conclusions: Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.

AB - Objective: This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block. Methods: From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 ± 5.6 days and 2.8 ± 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets. Results: Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 ± 2.6 mV and atrial voltage threshold was 0.8 ± 0.3 V. Mean R-wave sensing was 13.0 ± 5.7 mV and ventricular voltage threshold 0.9 ± 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 ± 7.1 years with 1 patient lost to follow-up. Conclusions: Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.

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