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Pacemaker therapy in children with complete heart block
Insights
Permanent pacemaker therapy using P-wave synchronous epicardial pacemakers is effective for children with complete heart block. This study shows long-term efficacy with manageable pulse generator replacements for pediatric complete heart block management.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Biomedical Engineering
Background:
- Complete heart block in children necessitates permanent pacemaker implantation.
- P-wave synchronous epicardial pacemakers offer a potential therapeutic solution.
- Indications include postsurgical heart block, heart failure, syncope, and arrhythmias.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of implanted P-wave synchronous epicardial pacemakers in pediatric patients with complete heart block.
- To assess the need for pulse generator replacements and identify associated complications.
Main Methods:
- Ten pediatric patients (8 months to 15 years) with complete heart block received P-wave synchronous epicardial pacemakers.
- Patients were followed for 38 to 108 months post-implantation.
- Data collected included indications for pacing, pulse generator replacements, and adverse events.
Main Results:
- Two deaths occurred, unrelated to pacemaker malfunction.
- Eight children were followed long-term with 27 pulse generator replacements (23 for battery, 3 for electromechanical failure, 1 for arrhythmia).
- Eight instances of rhythm disturbances were noted; no infections occurred.
Conclusions:
- Implanted P-wave synchronous pacemakers are an effective therapy for children with complete heart block.
- The procedure demonstrates a favorable long-term safety profile with manageable device-related issues.
- This pacing modality provides a reliable solution for pediatric complete heart block when indicated.
Abstract:
Permanent pacemaker therapy in children with complete heart block is necessary occasionally. Ten patients ranging in age from 8 months to 15 years were treated with an implanted P-wave, synchronous epicardial pacemaker. Indications for implantation were persisting postsurgical heart block, congestive failure, syncopal attacks, and arrhythmias. There were two deaths not attributed to pacemaker malfunction. The remaining eight children have been followed up for 38 to 108 months. There have been 27 pulse generator replacements. Twenty-three were for battery exhaustion, three for electromechanical failure, and one was due to arrhythmia. Rhythm disturbances have occurred on eight occasions. There have been no infections. It is concluded that the implanted P-wave synchronous pacemaker is an effective method of therapy when indicated for children with complete heart block.
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