Po-03-077 central venous occlusion in pediatric patients with transvenous device lead re-implantations

Central venous occlusion is a risk when using transvenous pacemaker leads, which may complicate repeated lead implantation. This is particularly important in young children with small body sizes, who often need an upgrade from single to dual chamber device later in life. Furthermore, lead survival is reported to be shorter in children compared to adults. Despite this, there are limited data on venous access patency during repeated lead implantations in patients receiving their first transvenous device during childhood. We aimed to assess the rate of central venous occlusion at repeated and third transvenous lead implantation in patients, who received their first transvenous device during childhood. All children who received a transvenous pacemaker or ICD before the age of 15 and had a repeat transvenous lead implantation were identified in the Danish National Pacemaker and ICD Registry. Patient and device characteristics were retrieved from medical charts. Between 1977 and 2021 284 children had a transvenous device implanted. Median age at first implantation was 7.4(IQR2.9-11.3) years. 139 patients underwent re-implantation of lead after median 7.7(IQR2.7-10.5) years. Most frequent causes of re-implantation were lead failure, lead fracture and growth-related lead problems. At first re-implantation, nine patients (6.5%) had venous occlusion of which three patients (2.2%) led to using the contralateral venous access. It was found that age below 7 years at first lead implantation predicted venous occlusion at first reimplantation(P-value 0.04). Median age at second lead re-implantation was 18.1(IQR 13.2-22.5) years. Median time between first and second lead re-implantation was 4.6(IQR 1.4-7.0) years. At second re-implantation, seven patients (5.0%) had venous occlusion. Repeatedly, age below 7 years was a risk factor of venous occlusion (P-value 0.02). In pediatric patients with repeated transvenous lead implantation, 6.5% had a venous occlusion at first re-implantation and 5.0% at second reimplantation. Age below 7 years was found to be a risk factor of venous occlusion at both first and second re-implantation. To increase transvenous patency in children with life-time device need, transvenous lead implantation should be avoided at age below 7 years.