Related Experiment Videos
[Complications and sequelae of cardiac electrostimulation in children. Our experience with 47 children]
1Dipartimento Cardiologico de Gasperis, Ospedale Maggiore Niguarda, Milano.
Insights
Pediatric cardiac pacing is feasible, but long-term results show significant morbidity. Epicardial pacing in children had higher revision rates than transvenous, highlighting the need for careful consideration of pacing methods.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Implantable Devices
Context:
- Permanent cardiac pacing is increasingly common in pediatric populations, including infants.
- However, comprehensive data on the long-term outcomes and associated complications in children remain limited.
Purpose:
- To analyze the institutional experience with permanent pacemaker implantation in pediatric patients.
- To determine the morbidity and identify factors influencing the need for pacemaker revisions in children.
Summary:
- This study reviewed 47 pediatric patients (mean age 8.3 years) who underwent pacemaker implantation over 10 years.
- Common indications included atrioventricular block and sick sinus syndrome.
- Twelve patients (29%) required 19 revisions, with lead fracture, rising thresholds, growth issues, and infection being primary causes. Epicardial pacing showed higher revision rates (52%) compared to transvenous (22%).
Impact:
- Findings underscore the feasibility of pediatric cardiac pacing while emphasizing the substantial long-term morbidity.
- The data suggest a higher complication rate with epicardial compared to transvenous lead implantation in children.
- This highlights the importance of device selection and surgical approach for optimizing long-term outcomes in pediatric pacing.
Abstract:
Permanent cardiac pacing is now easily feasible in children and even in small infants, but the long-term results of this procedure are not well known. We analyzed our experience to determine the morbidity of pacing in children. Over the past 10 years, 47 pediatric patients (pts) required pacemaker implantation in our institution. The mean age was 8.3 +/- 4 years (1 day-17 years) and mean body weight was 23 +/- 14 Kg (2.2-60 Kg). 25 pts had heart disease. 40 children had an A-V block (congenital in 22 cases, post-operative in 17 pts, and secondary to a systemic disease in 1 case); 7 pts had a sick sinus syndrome, primitive in 4 and postoperative in 3 cases. The first pacemaker implantation was epicardial in 17 and transvenous in 30 pts. The pacing was single-chamber in 45 pts (VVI 32, VVIr 7, AAI 5, AAIr 1) and dual-chamber in 2 pts (DDD 1, VDD 1). Two newborns, both with a congenital A-V block and severe heart failure, died in the first hours after epicardial pacing. Two other children, both with congenital heart disease, died during follow-up, but the death was not pacemaker-related. Finally, two children were lost to follow-up. The mean follow-up of the 41 remaining pts was 5.2 +/- 3.5 years (4 months-10 years). Twelve children (29%) required 19 implant revisions and the causes were: lead fracture (26%), rising stimulation threshold (26%), growth problems (21%), erosion and/or pocket infection (21%). Revisions were more common in epicardial (52%) than in endocardial (22%) implantation.(ABSTRACT TRUNCATED AT 250 WORDS)