The bail out option; using endocardial pacing and defibrillation leads epicardially

Abstract Introduction Although transvenous implantation of cardiac pacemakers and defibrillators is technically feasible and less invasive than surgical placement of epicardial leads, certain patients including pediatric patients and patients with complex congenital heart disease will require epicardial pacing and most of them will need pacing throughout their whole life. There are specific leads for epicardial pacing which were developed over time to the currently used bipolar steroid-eluting epicardial leads which may be rarely nationally unavailable. In addition, there are no available dedicated epicardial shock leads (1,2). There is no enough data on the techniques, feasibility, and efficacy of using endocardial leads, including shock leads for epicardial pacing/ defibrillation (3). Purpose We aim to describe our center’s experience in implanting endocardial leads for epicardial pacing or defibrillation and to assess its feasibility 4 of them had long QT syndrome and two had idiopathic VF. The mean follow-up periods were 38 months. Throughout the visits, the pacing thresholds, sensing functions, lead and shock impedances were stable in all patients (Table 1). Two of the patients with epicardial ICDs received appropriate shocks. None received inappropriate shocks. So far, only one patient required battery replacement. Conclusion In view of our findings, using endocardial leads as a bail out alternative to epicardial leads for pacing or defibrillation appears to be safe and effective. This finding is essentially important regarding the shock leads as there are no dedicated epicardial defibrillation leads. It should be noted that these results depend largely on the surgeon’s experience and on achieving acceptable pacing parameters and defibrillation thresholds intraoperatively.Table 1Figure 1