Related Experiment Videos
[Cardiac pacing in children with breath-holding spells]
E Villain1, V Lucet, D Do Ngoc
1Service de cardiologie pédiatrique, hôpital Necker-Enfants malades, Paris.
Insights
Pacemaker implantation effectively treated severe breath-holding spells in 11 children unresponsive to medical therapy. This intervention led to symptom disappearance and restored normal activities, offering a solution for severe cases.
Area of Science:
- Pediatric Cardiology
- Neurology
Context:
- Breath-holding spells (BHS) are common but can be severe.
- Severe BHS can cause loss of consciousness, seizures, and significant familial anxiety.
- Medical treatments for severe BHS are often unsuccessful.
Purpose:
- To evaluate the efficacy of pacemaker implantation in children with severe breath-holding spells.
- To assess the long-term outcomes and safety of pacemaker use in this pediatric population.
Summary:
- Eleven children with severe BHS underwent pacemaker implantation due to symptom severity or familial anxiety.
- Pacemaker implantation, via epicardial or endocardial approaches, resulted in the spectacular disappearance of spells and restoration of normal activities.
- While recurrences occurred in 3 patients, overall outcomes were positive, with 4 patients fully recovering and 5 remaining vagotonic.
Impact:
- Pacemaker implantation is a highly effective treatment for suppressing symptoms in severely affected children with breath-holding spells.
- This intervention can significantly improve quality of life for affected children and their families.
- The study highlights a viable therapeutic option when conventional treatments fail.
Abstract:
Breath-holding spells are common and usually benign. However, the authors chose to implant a pacemaker in children presenting with severe symptoms. Over the last 15 years, 11 children with severe breath-holding spells were paced. All had reflex spells with loss of consciousness, spontaneously or after minor trauma, and 6 had seizures. All had a normal ECG with marked bradycardic responses to ocular pressure. The 24 hour ECG showed pauses (12-25 s) in 4 patients, sudden bradycardia (< 30/min) in 3 patients, and sinus arrhythmia in the remaining 4 patients. Medical treatment has been unsuccessful. Pacemaker implantation was decided because of the severity and/or the frequency of the episodes in 10 children, and because of intolerable familial anxiety in the other one. Age at implantation ranged from 14 months to 5.5 years (mean: 16.5 +/- 20 months). The device was implanted by an epicardial (7) or from an endocardial (4) approach. All had a ventricular demand device, except for one who was paced from the atrium. The results were spectacular, with disappearance of spells and restoration of normal activities. Holter monitoring showed normal function of the pacemakers. Recurrences were observed in 3 patients, either due to loss of capture (2 cases) or to the need for explantation because of cutaneous erosion. Follow-up ranged from 10 months to 14 years (mean: 7.9 +/- 4.2 years); 2 patients were lost to follow-up; 4 patients totally recovered and only 5 are still vagotonic. Two pacemakers have been changed at 13 and 15 years respectively. The authors conclude that although psycho-social factors play a part in breath-holding spells, pacemaker implantation is very effective in suppressing symptoms in severely affected children.