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Implantable pacemakers in children
Insights
Implantable pacemakers can provide long, active lives for children with congenital heart defects, despite requiring frequent reoperations for device issues. Careful management of pacing systems is crucial for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Arrhythmias in children necessitate permanent pacemaker implantation.
- Congenital, postoperative, and viral causes are identified.
- Early and late mortality rates are significant concerns.
Purpose of the Study:
- To evaluate the long-term outcomes of permanent pacemaker implantation in pediatric patients.
- To identify causes of mortality and reoperation in this cohort.
- To assess the impact of reoperation on patient survival and quality of life.
Main Methods:
- Retrospective analysis of 12 pediatric patients (2 weeks to 6 years) who received permanent pacemakers.
- Review of implantation indications, device-related complications, reoperation rates, and survival data.
- Analysis of causes of death and long-term follow-up.
Main Results:
- One operative death and two late deaths occurred, the latter in patients with repaired tetralogy of Fallot.
- High reoperation rate (37 times) for pacemaker exhaustion and electrode issues.
- Nine of 12 patients survived long-term (9 months to over 10 years), with three surviving 8-10 years.
Conclusions:
- Despite high reoperation rates for device issues, permanent pacemakers can lead to long, active lives in children.
- Diligent management and correction of pacing system defects are critical for favorable outcomes.
- Ventricular arrhythmias may contribute to late mortality in specific complex congenital heart disease cases.
Abstract:
Permanent pacemakers were implanted in 12 children, ages 2 weeks to 6 years. The cause of the arrhythmia was congenital in three, postoperative in six, viral in one, and unknown in two. One operative death occurred on the second postoperative day. Two late deaths occurred five and 10-1/2 years postoperatively. The late deaths were in patients with good cardiac capture in whom the block followed repair of tetralogy of Fallot. Ventricular arrhythmias were believed to be the cause of death. Reoperation was required 37 times: for pacemaker exhaustion, 17; electrode problems, 15; wound problems, four; and arrhythmia, one. Nine of 12 patients are alive nine months to ten years eight months postoperatively. The remaining three survived for eight to ten years. Frequent reoperation and dilligent correction of defective pacing is rewarded with long, active lives in children requiring implantable pacemakers.