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Ann Thorac Surg 1994;58:97-102
© 1994 The Society of Thoracic Surgeons

Articles

Transatrial lead placement for endocardial pacing in children

Mark H. Hoyer, MD*, Lee B. Beerman, MD, Jose A. Ettedgui, MD, Sang C. Park, MD, Pedro J. Del Nido, MD, Ralph D. Siewers, MD

Divisions of Pediatric Cardiology and Cardiothoracic Surgery, Children's Hospital and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA

Accepted for publication November 1, 1993.

* Address reprint requests to Dr Hoyer, Wilford Hall USAF Medical Center/PSP, 2200 Bergquist Dr, Suite 1, Lackland AFB, TX 78236-5300.

Transvenous placement of endocardial leads in children may be difficult due to restrictions and complications of vascular access. We have placed endocardial leads from a transatrial approach in 5 children with various cardiac malformations. The usual surgical approach involved an anterolateral thoracotomy and, under fluoroscopic guidance, passage of the lead tip directly through the right atrial wall and across the tricuspid valve to the apex of the right ventricle. At a mean follow-up time of 23.2 months (range, 12.0 to 27.9 months), all patients have low thresholds for myocardial capture, and there have been no complications. We conclude that placement of endocardial leads by a transatrial approach provides an excellent alternative to an epicardial system in children destined for lifelong pacing.




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