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Implantation of SelectSecure™ Leads in Children

Conventional pacemaker leads have a lumen to help facilitate lead implantation and extraction. To achieve a small diameter (4.1 Fr), a bipolar, fix-screw, steroid-eluting, lumenless lead (SelectSecureTM lead, model 3830, Medtronic, Minneapolis, MN, USA) was developed.1,2 The small diameter of the SelectSecureTM lead is accomplished with the removal of the stylet lumen. Removal of the lumen may also facilitate the lead extraction since a locking stylet is not going to be needed. Because of the lack of lumen, the delivery of this lumenless lead is performed using an 8.4-Fr deflectable catheter. Following advancement of the SelectSecureTM catheter to the desired location along with the dilator and the guidewire, the lead is fixated at the target site with rotation of the lead body. A recent multicenter study revealed the safety and efficacy of this new lead design.1 At 3-month follow-up, atrial lead complication rate was 3% and ventricular lead complication rate was 5.9%. The lead dislodgement was the most common complication for both leads. The author noted a decreased complication rate following training sessions held to aim at improving implant techniques. Because of the durability and lower thresholds associated with endocardial pacing, this approach is preferred to epicardial pacing by most pediatric centers in the absence of precluding factors such as intracardiac shunts or young age. Silvetti et al. recently reported their 20-year experience with pediatric cardiac pacing and demonstrated significantly higher epicardial lead failures compared to the endocardial leads (31% vs 9%).3 Despite its advantages, transvenous pacemaker implantations have certain limitations in children. One major concern is venous obstruction.4 Pacemaker leads with smaller body design may help in preservation of venous patency in children. A recent study by Bar-Cohen et al. demonstrated venous obstruction of variable degrees in 25% of chronically paced children.5 One of the interesting findings of that