Pacing therapy in children with isolated complete atrioventricular block: a retrospective study of pacing system survival and pacing-related complications in a national cohort
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".