Permanent pacemaker therapy in corrected transposition of the great arteries: Analysis of site of lead placement in 40 patients

Abstract

A retrospective analysis of 58 pacemaker leads in 40 patients with corrected transposition of the great arteries (CTGA) was made to compare the function of endocardial and epicardial leads. Extensive trabeculations of the normal right ventricle are generally thought to be essential for endocardial pacemaker lead stability. Because the systemic venous ventricle in CTGA lacks an extensive trabecular network, there has been concern that transvenous lead placement may result in a high rate of dislodgement. Epicardial leads have been assumed to be more reliable in these patients. Forty-seven epicardial and 11 endocardial leads were placed in 40 patients with CTGA who required permanent pacemaker therapy for symptomatic bradycardia. Of 13 episodes of epicardial lead malfunction in 158 patient-years, 3 were due to lead fracture and 10 to high thresholds. Surgery was required to correct the lead malfunction in 12 instances and thoracotomy was necessary for new lead placement in 6 patients. During 26.2 patient years, there were 2 episodes of endocardial lead failure due to a high acute threshold and perforation. There were no instances of endocardial lead dislodgement. No association between type of failure and lead design was noted for either endocardial or epicardial leads. Actuarial analysis of survival revealed no significant differences in reliability between endocardial and epicardial leads. Endocardial lead fixation in the systemic venous ventricle in patients with CTGA is adequate to prevent lead dislodgement and preferable to epicardial lead placement because thoracotomy is avoided.