In the Journals

Coronary artery compression becoming more common in children with epicardial leads

There was a higher rate of coronary artery compression in children with epicardial leads than was reported in the literature, according to a study published in HeartRhythm.

“The use of pacemakers and defibrillators in children is growing,” Douglas Y. Mah, MD, director of the pacemaker and ICD program in the department of cardiology at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, said in a press release. “As more epicardial devices are implanted, more children may be at risk for developing coronary compression from their leads. We hope to increase awareness among health care providers and patients of this important, possibly preventable and potentially fatal complication and provide a useful screening algorithm to detect at-risk patients and ultimately prevent complications.”

Researchers analyzed data from 145 children (57% boys; median age at implantation, 2 years; median age at most recent imaging, 9 years) with epicardial leads who underwent catheter angiography or ECG-gated cine CT after implantation. At the time of implantation, catheter angiography and/or CT, information was collected including indication for pacing, presence of structural heart disease, demographics and type of pacing or defibrillation system placed.

Coronary artery compression was diagnosed in 5.5% of patients at a median age of 11.4 years. This was diagnosed by catheter angiography in six patients, CT in six patients and one during postmortem analysis.

Chest radiography had a sensitivity of 57% and a specificity of 96%, whereas CT had a sensitivity of 100% and a specificity of 93%. Sensitivity was 86% and specificity was 100% for catheter angiography.

At the time of lead implantation, patients with and without coronary artery compression did not have significant differences in weight (9.5 kg vs. 11.8 kg, respectively; P = .46) and age (1.3 years vs. 2.4 years, respectively; P = .36).

Among children with coronary compression, 75% had symptoms, including chest pain, sudden death and unexplained fatigue.

Surgical removal or repositioning of the epicardial lead was performed in seven patients with coronary artery compression.

“All cardiologists who have patients with epicardial electrodes should always be aware of this potential complication and assess patients for coronary issues, at the least with a periodic chest radiograph,” Gerald A. Serwer, MD, FHRS, professor at C.S. Mott Children’s Hospital at University of Michigan in Ann Arbor, wrote in a related editorial. “When evidence strongly suggests ischemia secondary to coronary compression due to electrode position, electrode replacement must be considered in view of the potential morbidity and mortality. I strongly concur with Mah et al that any additional information that can aid in risk assessment would be of benefit and that further studies to establish the efficacy of nuclear cardiology techniques are indicated.” – by Darlene Dobkowski

Disclosures: The authors and Serwer report no relevant financial disclosures.

There was a higher rate of coronary artery compression in children with epicardial leads than was reported in the literature, according to a study published in HeartRhythm.

“The use of pacemakers and defibrillators in children is growing,” Douglas Y. Mah, MD, director of the pacemaker and ICD program in the department of cardiology at Boston Children’s Hospital and assistant professor of pediatrics at Harvard Medical School, said in a press release. “As more epicardial devices are implanted, more children may be at risk for developing coronary compression from their leads. We hope to increase awareness among health care providers and patients of this important, possibly preventable and potentially fatal complication and provide a useful screening algorithm to detect at-risk patients and ultimately prevent complications.”

Researchers analyzed data from 145 children (57% boys; median age at implantation, 2 years; median age at most recent imaging, 9 years) with epicardial leads who underwent catheter angiography or ECG-gated cine CT after implantation. At the time of implantation, catheter angiography and/or CT, information was collected including indication for pacing, presence of structural heart disease, demographics and type of pacing or defibrillation system placed.

Coronary artery compression was diagnosed in 5.5% of patients at a median age of 11.4 years. This was diagnosed by catheter angiography in six patients, CT in six patients and one during postmortem analysis.

Chest radiography had a sensitivity of 57% and a specificity of 96%, whereas CT had a sensitivity of 100% and a specificity of 93%. Sensitivity was 86% and specificity was 100% for catheter angiography.

At the time of lead implantation, patients with and without coronary artery compression did not have significant differences in weight (9.5 kg vs. 11.8 kg, respectively; P = .46) and age (1.3 years vs. 2.4 years, respectively; P = .36).

Among children with coronary compression, 75% had symptoms, including chest pain, sudden death and unexplained fatigue.

Surgical removal or repositioning of the epicardial lead was performed in seven patients with coronary artery compression.

“All cardiologists who have patients with epicardial electrodes should always be aware of this potential complication and assess patients for coronary issues, at the least with a periodic chest radiograph,” Gerald A. Serwer, MD, FHRS, professor at C.S. Mott Children’s Hospital at University of Michigan in Ann Arbor, wrote in a related editorial. “When evidence strongly suggests ischemia secondary to coronary compression due to electrode position, electrode replacement must be considered in view of the potential morbidity and mortality. I strongly concur with Mah et al that any additional information that can aid in risk assessment would be of benefit and that further studies to establish the efficacy of nuclear cardiology techniques are indicated.” – by Darlene Dobkowski

Disclosures: The authors and Serwer report no relevant financial disclosures.