12. Cardiac ResynchronizationTherapy: Surgical Approach.

Introduction Young infants suffering from congenital or postoperative AV-block require life-long pacemaker stimulation. Due to the anatomical prerequisites initially epicardial electrodes are implanted and the generator is placed in the upper abdominal wall. The following study investigated modes of failure leading to reoperation in this group of technically challenging patients. Methods Between 10/2000 and 05/2005 a total of 21 infants (age 3 days to 5 years) underwent pacemaker implantation using a partial lower or complete median sternotomy. Nine had previous cardiac surgery for complex congenital defects. Different uni- and bipolar epicardial electrodes (Medtronic Capsure® epi) were fixed to the right ventricle, 15 had additional implantation of a bipolar atrial lead. The pacemaker generator (Medtronic Kappa® 701) was implanted into the right upper abdominal wall. A total of four reoperations occurred during the follow up period (19%), indications for revision were recorded. Results Three of the four revisions were caused by ventricular electrode fracture. At revision two electrodes were broken at the crossing between thorax and the abdominal wall, one bipolar lead at the division into the two tip electrodes. One reoperation was due to a pacemaker recall. All revisions could be performed by electrode or pacemaker change without complications. Pacing and sensing parameters remained stable during midterm follow-up. Conclusion Epicardial pacing in young infants is associated with a significant number of failures leading to reoperation, mainly due to electrode fracture caused by the muscular activity of this patient group. Reoperations can be performed at a low risk. [ABSTRACT FROM PUBLISHER]