Cardiac strangulation following epicardial pacemaker implantation: A rare pediatric complication

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 149; no. 2; pp. 522 - 527
• Main Authors: Carreras, Erick M, Duncan, Walter J., MD, FRCP(C), FACC, Djurdjev, Ognjenka, BAH, MSc, Campbell, Andrew I.M., BSc, MD, FRCS(C)
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015
• Subjects: Adolescent; Cardiac Pacing, Artificial - adverse effects; Cardiac Pacing, Artificial - mortality; Cardiothoracic Surgery; Child; Child, Preschool; Critical Pathways; Device Removal; Electrodes, Implanted - adverse effects; Equipment Failure; Female; Heart Defects, Congenital - therapy; Humans; Incidence; Infant; Infant, Newborn; Male; Myocardial Ischemia - etiology; Myocardial Ischemia - mortality; Pacemaker, Artificial - adverse effects; Prognosis; Prospective Studies; Retrospective Studies; Young Adult; 44; computed tomography; cardiac strangulation; 36; CI; epicardial pacemaker; EP; posteroanterior; CS; CT; PA; SD; 24.1; confidence interval; 20; standard deviation
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.10.094

Objectives The aim of our study was 2-fold: to determine the incidence of cardiac strangulation (CS) and to develop a clinical pathway to aid in the diagnosis and prognosis of CS. In <2 years, 2 cases of CS occurred in our institution, which caused much alarm and led to the study's objectives. Methods All patients who underwent implantation of an epicardial pacemaker from January 1992 to March 2012 were included. There were no exclusion criteria. Health records were used to locate all subjects and gather all retrospective data. Prospectively, subjects without a chest radiograph from the previous 2 years were approached for imaging. Results This study included 86 patients retrospectively, and 84 patients prospectively. There was a 2.3% incidence, and a 1.2% mortality, related to CS. A pattern of posterior looping of the ventricular lead was seen in radiographs of both CS-diagnosed patients. Five variables were significantly associated with an outcome of CS ( P  = .0153). Conclusions Our data indicate that the 2 cases of CS were not caused by a lack of follow-up but by a lack of consistent imaging for diagnosis. This conclusion is supported by the 8 cases of CS found in the English-language literature. If the patient is age ≤6 months at the time of implantation, particular attention should be given to the placement of leads and follow-up.