The authors propose that patients with concerning chest x-rays, symptoms such as unexplained chest pain or tiredness, or evidence of heart muscle damage or dysfunction should ideally have a cine CT scan that can image the heart moving in relation to the epicardial wires. Although this can also result in a false-positive, CT is less risky for pediatric patients because radiation doses are now much lower for this non-invasive imaging method.
If cine CT is not available, they advocate that patients undergo catheter angiography to confirm the diagnosis before taking a patient to surgery.
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"The use of pacemakers and defibrillators in children is growing," noted Dr. Mah. "As more epicardial devices are implanted, more children may be at risk for developing coronary compression from their leads. We hope to increase awareness among healthcare providers and patients of this important, possibly preventable, and potentially fatal complication and provide a useful screening algorithm to detect at-risk patients and ultimately prevent complications."
"This article clearly emphasizes the need to not only carefully evaluate the potential site of electrode head fixation to avoid coronary injury, but also the need to evaluate closely where to route the electrode body to the device pocket," commented Gerald A. Serwer, MD, FHRS, pediatric cardiologist at the University of Michigan's C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, MI, USA, in an accompanying editorial.
Dr. Serwer emphasizes that all cardiologists who have patients with epicardial electrodes should always be aware of this potential complication and periodically assess patients for coronary issues with at least a periodic chest x-ray. When evidence strongly suggests ischemia secondary to coronary compression due to electrode position, electrode replacement must be considered in view of the potential morbidity and mortality. "I strongly concur with the authors that any additional information one can obtain to aid in risk assessment would be of benefit and agree with them that additional studies to establish the efficacy of nuclear cardiology techniques are indicated," concluded Dr. Serwer.
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