Epicardial pacing remains a crucial option for specific indications, with bipolar leads showing lower malfunction rates (1% and 6% for atrial, 4% and 15% for ventricular leads at 2 and 5 years).
Epicardial pacing remains a crucial therapeutic option for specific patient populations, with bipolar leads demonstrating lower malfunction rates over time.
The first implanted pacing systems were epicardial. Only in 1962 first endocardial pacing was delivered. Although number of epicardial pacing systems is low, in selected cases this mode is the only therapeutic option. Epicardial systems should be considered in individuals who need permanent pacing and who are neonates or infant; in patients with congenital heart defects and right-to-left shunt; in case of inability to obtain vein access to target heart chamber; in patients with resynchronization system in whom hemodynamically effective pacing through epicardial veins is impossible; in those who are pacemaker dependant and require reimplantation of the system after extraction due to infective complications. In some, above mentioned cases, leadless pacing or totally subcutaneous cardioverter-defibrillator (S-ICD) could be an alternative. Both uni- and bipolar, steroid eluting leads are available. It seems that bipolar leads are less prone to malfunction, which is observed in 1 and 6% atrial; 4 and 15% ventricular leads after 2 and 5 years follow-up.
Mitkowski et al. (Fri,) conducted a review in Need for permanent pacing. Epicardial pacing was evaluated. Epicardial pacing remains a crucial option for specific indications, with bipolar leads showing lower malfunction rates (1% and 6% for atrial, 4% and 15% for ventricular leads at 2 and 5 years).