1. Transmural Placement of Endocardial Pacing Leads in Patients With Congenital Heart Disease 
Stany Sandrio, MD, Ariawan Purbojo, MD, Okan Toka, MD, Sven Dittrich, MD, Robert Cesnjevar, MD, André Rüffer, MD 
The Annals of Thoracic Surgery 
Volume 101, Issue 6, Pages (June 2016)
DOI: /j.athoracsur
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
(A) Representative transmural placement of endocardial pacing leads: a) atrial lead; b) transatrial ventricular lead; and c) transventricular ventricular lead. (Illustration by Stany Sandrio, MD.) (B) Transatrial approach. (C) Transventricular approach. Pacing leads are secured with sutures near its tip (*) and a purse-string suture at the lead entrance on the epicardial surface (**).
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Chest radiograph after transmural placement of endocardial pacing leads: (A) transmural placed (TML), bipolar endocardial atrial lead, and bipolar epicardial ventricular lead; (B) TML atrial and transatrial TML ventricular leads.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Transmural placement of endocardial pacing leads with concomitant tricuspid valve replacement. (A) An endocardial lead was placed through the atrial wall and sandwiched between the tricuspid valve annulus and (B) tricuspid bioprothesis.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Average of pacing and sensing thresholds over time. The median follow-up period between transmural placement of endocardial pacing leads (TML), atrial pacing (TML-A) and ventricular pacing (TML-V), implantation and last follow-up was 2 years. Over time, although there was a tendency toward better pacing properties in both groups—TML-A (red bars = pacing threshold; pink bars = sensing threshold) and TML-V (dark blue bars = pacing threshold; light blue bars = sensing threshold)—the difference did not reach statistical significance. (*p < 0.01.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Kaplan-Meier analysis of time-related freedom from lead failure over follow-up period. The numbers of transmural leads (TML) still at risk of requiring replacement as primary endpoint are indicated. Kaplan-Meier freedom from lead failure after 1 and 5 years, respectively, was 73% ± 13% and 59% ± 17% in group TML-ventricular pacing (TML-V), and 100% in group TML-atrial pacing (TML-A [log rank p < 0.01]). There was no significant difference between transatrial and transventricular placed TML-V leads (log rank p = 0.55). (Blue line = group TML-A; green line = group TML-V; blue hatch marks = group TML-A censored; green hatch marks = group TML-V censored.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions