Children who require pacemakers or defibrillators to stimulate heart often need to have wires placed on the outside of their heart due to their unique anatomy.
These wires, on rare occasions, might lead to "cardiac strangulation" which can lead to coronary artery compression over time.
"Coronary artery compression is thought to be rare," said lead investigator Douglas Y. Mah, from the Boston Children's Hospital in the US.
"Its true incidence, however, may be higher than we believed due to either a lack of awareness or lack of reporting in the literature," he added.
In the study, published in the journal HeartRhythm, Mah and team recommended that paediatric patients with epicardial devices should get screening chest x-rays every few years to assess how their wires look in relation to their heart, as the positioning may change as the child grows.
They found that chest x-rays had a high specificity and was a good screening tool, easy to perform, inexpensive, and non-invasive.
Following the sudden death of a child with an epicardial pacemaker after coronary artery compression, the team enhanced surveillance of all patients with epicardial pacing or defibrillation systems.
They reviewed the records of all patients followed at Boston Children's Hospital from 2000-2017 who had either active or abandoned epicardial wires that included coronary imaging, either by computed topography (CT) scan or catheter angiography through the vessels in the leg.
Of the 145 patients, eight (5.5 per cent) exhibited some degree of coronary compression from their epicardial leads.
Six of these patients displayed symptoms. In addition to the case of sudden death, there were three cases of chest pain and two cases of unexplained fatigue.
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