Pacing therapy in children with isolated complete atrioventricular block: a retrospective study of pacing system survival and pacing-related complications in a national cohort
Notice bibliographique
Résumé
Eliasson et al.1 report on a large cohort of 127 paediatric patients who received 306 leads either endocardial or epicardial. As expected, their most important finding is that patients operated before 1-month of age have the worst outcome. Additionally, patients operated in the most recent era tend to do better. Again, this is not surprising as it likely represents the advances in the medical and surgical approach of these patients. In our view, the most interesting finding is that system survival was similar between endocardial and epicardial leads. This finding is reassuring for the myriad of kids with epicardial leads. We would like to make a few comments on this particular finding as it was not made by the authors. The first comment pertains to the durability of the epicardial leads. The authors candidly admitted that they were surprised by the finding that epicardial and endocardial lead survival was similar. In truth, they had hypothesized that the epicardial system would perform less favourably. We cannot condemn the authors for such presupposition, since epicardial leads were previously associated with a higher risk of failure and linked to a higher risk of mortality in certain circumstances.2,3 Nevertheless, some recent studies have reported encouraging outcomes and lead longevity with epicardial systems.4 We think it is worth saying that epicardial leads are a reliable option when endovascular dwelling is not desired. However, we are concerned that this lack of difference between epicardial and endocardial systems would be interpreted as a plea for endovascular implants even in the youngest. In fact, the authors simply underlined that epicardial leads do better than expected. However, we are concerned that these results may be used by some physicians to favour the use of endocardial leads in the smallest and youngest patients. One should remember that lead extraction complications, multiple leads, and venous occlusion were not assessed in this manuscript and will be seen later in the life of these young patients. Abandonment of an epicardial lead is associated with fewer risks than endovascular leads. As electrophysiologists and surgeons dedicated to paediatric, congenital, and device/extraction issues, we see both ends of the same spectrum. A growing portion of our practice is the extraction of leads for reasons such as endocarditis, venous thrombosis, and lead fracture. We encounter the damaging effect of abandoned leads and also the devastation left sometimes by lead extraction. There is no perfect solution that is devoted to risks. A stepwise approach of epicardial implants at a younger age and later conversion to a transvenous system would still be a viable approach supported by the long-term performance of epicardial leads nowadays. Conflict of interest: none declared.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».