{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:58:05Z","timestamp":1790683085610,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transvenous pacing in low\u2010weight children is technically feasible, but its clinical use depends on long\u2010term venous patency, system performance, and ventricular function. We aimed to describe imaging\u2010defined venous abnormalities and clinically overt vascular events after first transvenous pacemaker implantation and to explore whether the lead\u2010to\u2010vein ratio provides anatomical information beyond body weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective observational cohort included 35 children weighing \u226415\u00a0kg undergoing first transvenous pacemaker implantation between 2010 and 2020. The primary vascular endpoint was imaging\u2010defined venous thrombosis, occlusion, or stenosis \u226550%; clinical impact was recorded separately. Device\u2010related safety, minimum venous diameter, lead\u2010to\u2010vein ratio, ventricular function, synchrony, and paced QRS duration were analyzed using non\u2010parametric, exact, and exploratory univariable tests.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median follow\u2010up was 6.7 [4.5\u20138.2] years. Eleven patients weighed &lt;10\u00a0kg and 3 weighed &lt;5\u00a0kg. The imaging\u2010defined vascular endpoint occurred in 6\/35 patients; 5 were asymptomatic surveillance findings and 1 was clinically symptomatic. The lead\u2010to\u2010vein ratio was higher in patients with the endpoint than in those without events (0.59 [0.55\u20130.63] vs. 0.47 [0.43\u20130.51];\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003). A ratio &gt;0.55 was associated with more frequent imaging\u2010defined endpoints (4\/8\u00a0vs. 2\/27; odds ratio 12.5; 95% confidence interval 1.7\u201392.3). Left ventricular ejection fraction remained preserved.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>During the first transvenous system lifespan, imaging\u2010defined venous abnormalities were relatively frequent but mostly asymptomatic, whereas clinically overt vascular complications were uncommon. The lead\u2010to\u2010vein ratio may support anatomical pre\u2010implant risk stratification, although multicenter validation and follow\u2010up beyond generator replacement are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pace.70454","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:12:02Z","timestamp":1790680322000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lead\u2010to\u2010Vein Ratio and Long\u2010Term Vascular Safety After Transvenous Pacing in Children Weighing \u226415 Kg"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2258-0814","authenticated-orcid":false,"given":"Michel Cabrera","family":"Ortega","sequence":"first","affiliation":[{"name":"Department of Cardiology Parc Sanitari Sant Joan de Deu  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos Ramiro","family":"Novoa","sequence":"additional","affiliation":[{"name":"Cardiac Catheterization Laboratory Cardiocentro Pediatrico William Soler  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osmin Casta\u00f1eda","family":"Chirino","sequence":"additional","affiliation":[{"name":"Arrhythmia and Cardiac Pacing Service Instituto De Cardiologia y Cirugia Cardiovascular  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adel Eladio Gonz\u00e1lez","family":"Morej\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Echocardiography Cardiocentro Pediatrico William Soler  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giselle Serrano","family":"Ricardo","sequence":"additional","affiliation":[{"name":"Department of Echocardiography Cardiocentro Pediatrico William Soler  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4671-6310","authenticated-orcid":false,"given":"Yoel Coto","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Department of Cardiology Parc Sanitari Sant Joan de Deu  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mabel Elena Dominguez","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Cardiac Catheterization Laboratory Cardiocentro Pediatrico William Soler  La Habana Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1227-4593","authenticated-orcid":false,"given":"Liz Coto","family":"P\u00e9rez","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences University of Barcelona, Bellvitge Campus, L'Hospitalet De Llobregat  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0672-0696","authenticated-orcid":false,"given":"Agust\u00edn","family":"Fern\u00e1ndez\u2010Cisnal","sequence":"additional","affiliation":[{"name":"Department of Cardiology Parc Sanitari Sant Joan de Deu  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"e350","article-title":"ACC\/AHA\/HRS 2008 Guidelines for Device\u2010Based Therapy of Cardiac Rhythm Abnormalities","volume":"117","author":"Epstein A. E.","year":"2008","journal-title":"Circulation"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1136\/hrt.2009.173328","article-title":"Cardiac Pacing in Infants and Children","volume":"96","author":"McLeod K. A.","year":"2010","journal-title":"Heart"},{"key":"e_1_2_10_4_1","first-page":"23","article-title":"Special Problems of Pacing in Children","volume":"3","author":"Antretter H.","year":"2003","journal-title":"Indian Pacing Electrophysiol J"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1111\/j.1540-8159.1990.tb04013.x","article-title":"Endocardial Pacing in Infants and Children 15 Kg or Less in Weight: Medium\u2010Term Follow\u2010up","volume":"13","author":"Till J. A.","year":"1990","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1111\/j.1540-8159.2004.00663.x","article-title":"Endocardial Pacemaker Implantation in Infants Weighing \u226410 Kilograms","volume":"27","author":"Kammeraad J. A. E.","year":"2004","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/europace\/eum043","article-title":"Single\u2010Centre Experience on Endocardial and Epicardial Pacemaker System Function in Neonates and Infants","volume":"9","author":"Silvetti M. S.","year":"2007","journal-title":"Europace"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/j.hrthm.2015.04.025","article-title":"Low Incidence of Complication After Cephalic Vein Cutdown for Pacemaker Lead Implantation in Children Weighing Less than 10 Kilograms","volume":"12","author":"Kircanski B.","year":"2015","journal-title":"Heart Rhythm"},{"key":"e_1_2_10_9_1","article-title":"Twenty\u2010Seven Years Experience With Transvenous Pacemaker Implantation in Children Weighing <10 Kg","volume":"9","author":"Konta L.","year":"2016","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"key":"e_1_2_10_10_1","first-page":"581","article-title":"Long\u2010Term Outcome of Transvenous Pacemaker Implantation in Infants: A Retrospective Cohort Study","volume":"19","author":"Vos L. M.","year":"2017","journal-title":"Europace"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.recesp.2016.11.034","article-title":"Estimulaci\u00f3n Endoc\u00e1rdica de Ni\u00f1os con Peso Inferior a 10 Kilogramos","volume":"71","author":"Campos\u2010Quintero A.","year":"2018","journal-title":"Revista Espanola De Cardiologia"},{"issue":"1","key":"e_1_2_10_12_1","first-page":"S177","article-title":"Transvenous Pacing in Children Weighing Less than 10 Kilograms","volume":"32","author":"Robledo\u2010Nolasco R.","year":"2009","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1111\/j.1540-8167.2006.00489.x","article-title":"Age, Size, and Lead Factors Alone Do Not Predict Venous Obstruction in Children and Young Adults with Transvenous Lead Systems","volume":"17","author":"Bar\u2010Cohen Y.","year":"2006","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1111\/j.1540-8159.1997.tb03594.x","article-title":"Risk Factors for Venous Obstruction in Children With Transvenous Pacing Leads","volume":"20","author":"Figa F. H.","year":"1997","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1161\/CIRCULATIONAHA.112.115428","article-title":"Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site: A Multicenter Study","volume":"127","author":"Janousek J.","year":"2013","journal-title":"Circulation"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1111\/pace.13153","article-title":"What Endocardial Right Ventricular Pacing Site Shows Better Contractility and Synchrony in Children and Adolescents?","volume":"40","author":"Silvetti M. S.","year":"2017","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1016\/j.hrthm.2021.07.038","article-title":"2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients","volume":"18","author":"Shah M. J.","year":"2021","journal-title":"Heart Rhythm"},{"key":"e_1_2_10_18_1","first-page":"184","article-title":"Diastolic Dysfunction in Paced Children With Cardiac Defects","volume":"105","author":"Cabrera Ortega M.","year":"2015","journal-title":"Arquivos Brasileiros De Cardiologia"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/s00246-016-1523-3","article-title":"Key Role of Pacing Site as Determinant Factor of Exercise Testing Performance","volume":"38","author":"Cabrera Ortega M.","year":"2017","journal-title":"Pediatric Cardiology"},{"key":"e_1_2_10_20_1","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.echo.2012.10.014","article-title":"Measures of Dyssynchrony in the Left Ventricle of Healthy Children and Young Patients With Dilated Cardiomyopathy","volume":"26","author":"Thomas V. C.","year":"2013","journal-title":"Journal of the American Society of Echocardiography"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.hrthm.2016.10.017","article-title":"Risk Factors for Complications in the Implantation of Epicardial Pacemakers in Neonates and Infants","volume":"14","author":"Chaouki A. S.","year":"2017","journal-title":"Heart Rhythm"},{"key":"e_1_2_10_22_1","first-page":"1193","article-title":"Venous Access and Long\u2010Term Pacemaker Lead Failure: Comparing Contrast\u2010Guided Axillary Vein Puncture With Subclavian Puncture and Cephalic Cutdown","volume":"19","author":"Chan N. Y.","year":"2017","journal-title":"Europace"},{"key":"e_1_2_10_23_1","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jacep.2020.01.006","article-title":"Subclavian and Axillary Vein Access Versus Cephalic Vein Cutdown for Cardiac Implantable Electronic Device Implantation: A Meta\u2010Analysis","volume":"6","author":"Atti V.","year":"2020","journal-title":"JACC Clinical Electrophysiology"},{"key":"e_1_2_10_24_1","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1111\/pace.12283","article-title":"Percutaneous Axillary Vein Approach in Pediatric Pacing: Comparison With Subclavian Vein Approach","volume":"36","author":"Silvetti M. S.","year":"2013","journal-title":"Pacing and Clinical Electrophysiology"},{"key":"e_1_2_10_25_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4414\/cvm.2015.00328","article-title":"Axillary Vein Puncture for Device Implantation and Use of 4F Catheter\u2010Delivered Pacing Leads in Children","volume":"18","author":"Burgan H.","year":"2015","journal-title":"Cardiovascular Medicine"}],"container-title":["Pacing and Clinical Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70454","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pace.70454","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pace.70454","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:12:06Z","timestamp":1790680326000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pace.70454"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":24,"alternative-id":["10.1111\/pace.70454"],"URL":"https:\/\/doi.org\/10.1111\/pace.70454","archive":["Portico"],"relation":{},"ISSN":["0147-8389","1540-8159"],"issn-type":[{"value":"0147-8389","type":"print"},{"value":"1540-8159","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,29]]},"assertion":[{"value":"2026-07-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pace.70454"}}