The Annals of Thoracic Surgery, Vol 52, 118-121, Copyright © 1991 by The Society of Thoracic Surgeons
Transvenous pacemakers in children: relation of lead length to anticipated growth
A Gheissari, AJ Hordof and HM Spotnitz
Department of Surgery, Columbia-Presbyterian Medical Center, Columbia University College of Physicians and Surgeons, New York, New York.
Although transvenous pacing is feasible in infants and children,
uncertainty remains as to how to allow for future growth at the time of
lead insertion. Accordingly, we retrospectively reviewed the relation
between age and transvenous lead length. Standard posteroanterior chest
roentgenograms were reviewed for 26 patients with transvenous pacemakers
inserted at Babies Hospital and Presbyterian Hospital between 1985 and
1989. Sixteen of these were children (age range, 0.75 to 15 years) and 10
were adults (age range, 27 to 90 years). The intravascular length of right
ventricular pacing leads was measured as projected on the roentgenogram. In
10 children, the presence of lead loops in the right atrium required the
lead length that would have resulted from conventional placement to be
estimated. Results for right ventricular pacing lead lengths were
correlated with age using linear regression analysis. Average uncorrected
lead length measured on the roentgenogram was 345 +/- 35 mm (standard
deviation) in adults and 222 +/- 51 mm in children. The use of right atrial
loops increased implanted lead length by an estimated 79 mm, from 188 +/-
26 to 267 +/- 43 mm. The difference between lead length in children and
adults was analyzed. Approximately 190 mm of additional right ventricular
pacing lead in infants and 100 mm in 10-year-old children was needed for
growth to adult size. We conclude that an 80-mm right atrial lead loop will
allow 6 to 12 years (mean, 8 years) of growth in infants and children
without the need for reoperation to adjust lead length.
