{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:39:34Z","timestamp":1790091574593,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T00:00:00Z","timestamp":1705622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A major issue of cardiac implantable electronic device therapy in pediatric patients is the high incidence of lead dysfunctions and associated reinterventions. This study aims to analyze the timing and mode of generator and lead dysfunction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective single\u2010center analysis of 283 children and young adults with an epicardial pacemaker or implantable cardioverter defibrillator therapy from 1998 to 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age at implant was 6.1 years (SD\u00a0\u00b1\u00a05.8 years) and median follow\u2010up 6.4 years (IQR, 3.4\u201310.4 years) with a total of 1998.1 patient\u2010years of cardiac device therapy. A total of 120 lead\u2010related complications were observed in 82 patients (29.0%). They were detected by device interrogation (<jats:italic>n<\/jats:italic>\u00a0=\u00a086), symptoms (<jats:italic>n<\/jats:italic>\u00a0=\u00a013), intraoperative findings (<jats:italic>n<\/jats:italic>\u00a0=\u00a07), routine chest radiography (<jats:italic>n<\/jats:italic>\u00a0=\u00a05), routine ECG (<jats:italic>n<\/jats:italic>\u00a0=\u00a04), patient alert sound by device (<jats:italic>n<\/jats:italic>\u00a0=\u00a03), and physical examination (<jats:italic>n<\/jats:italic>\u00a0=\u00a02). It was possible to find the date of the event on the device memory in 21 out of 120 lead dysfunctions (18%) with a median time interval between occurrence and detection of 1.3 months (IQR, 0.2\u20135.0 months). Moreover, 20 generator\u2010related complications were found in 13 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early recognition of lead and generator dysfunction remains challenging in pediatric patients. As symptoms are relatively rare conditions in the context of PM and ICD dysfunction, close patient monitoring is mandatory, even in asymptomatic patients with a good clinical course. To further improve the safety of pediatric pacing systems, more durable epicardial electrodes are desirable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14919","type":"journal-article","created":{"date-parts":[[2024,1,19]],"date-time":"2024-01-19T11:14:45Z","timestamp":1705662885000},"page":"321-329","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lead and generator dysfunction in children and adolescents with epicardial pacemaker and implantable cardioverter defibrillator systems: The challenge of early recognition"],"prefix":"10.1111","volume":"47","author":[{"given":"Florian","family":"Winkler","sequence":"first","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie","family":"von Felten","sequence":"additional","affiliation":[{"name":"Department of Biostatistics at Epidemiology Biostatistics and Prevention Institute University of Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Gass","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6905-8839","authenticated-orcid":false,"given":"Florian","family":"Berger","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Weber","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitendu","family":"Dave","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1358-3535","authenticated-orcid":false,"given":"Christian","family":"Balmer","sequence":"additional","affiliation":[{"name":"Division of Pediatric Cardiology &amp; Congenital Cardiovascular Surgery Pediatric Heart Centre Department of Surgery University Children's Hospital Zurich  Zurich Switzerland"},{"name":"Children's Research Centre University Children's Hospital Zurich  Zurich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2011.09.004"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00834-0"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2004.02.020"},{"key":"e_1_2_10_5_1","article-title":"Long\u2010term outcome of epicardial implantable cardioverter\u2010defibrillator systems in children: results justify its preference in paediatric patients","volume":"20","author":"Winkler F","year":"2017","journal-title":"Europace"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.5603\/KP.a2018.0089"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jce.13502"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1540-8167.2004.03388.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119578376"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-020-02332-z"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10047-012-0668-y"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcts.2005.06.040"},{"key":"e_1_2_10_13_1","volume-title":"R: a language and environment for statistical computing","author":"Team RC","year":"2022"},{"key":"e_1_2_10_14_1","unstructured":"TherneauT Coxme: mixed effects cox models. 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