Exit block in pediatric cardiac pacing. Comparison of the suture-type and fishhook epicardial electrodes

Ninety-seven consecutive permanent epicardial pacemaker implantations were performed with either suture-type (group I, n = 52) or fishhook electrodes (group II, n = 45). In addition to epicardial fixation of the electrodes at the collar area, the suture-type was further secured in place by tying the electrode's suture at its exit to another nonabsorbable pledget-supported suture. Acute thresholds and slew rates were not significantly different between the two groups. Although the R wave was lower in group I (8.4 ± 3.5 mV) than in group II (11.8 ± 6, p < 0.01), no sensing problems occurred. The larger surface area of suture-type electrode led to lower resistance in group I (271 ± 61 Ω) compared with group II (356 ± 72, p < 0.001); however, the difference in pacemaker generator longevity did not appear significant (group I, n = 12, mean 4.7 ± 1.6 years; group II, n = 4, mean 5 ± 0.6 years). The incidence of exit block was significantly higher in group II (40%, 18/45) than in group I (8%, 4/52, p < 0.01). The length of the stimulation tip and better fixation of the suture-type electrode probably accounted for the observed difference in the incidence of exit block between the two electrodes.