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[Permanent pacemakers in children. The indications, complications and long-term follow-up]
R Camacho-Casillas1, A Vizcaíno-Alarcón, N García-Hernández
1Hospital Regional 20 de Noviembre, Instituto de Seguridad y Servicio Social para los Trabajadores del Estado, México, D.F., México.
Insights
Pacemakers effectively treat congenital and acquired heart block in children, with most patients experiencing normal growth and development. Reoperations were common, primarily due to battery failure or device malfunction.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Context:
- Pacemaker implantation in pediatric patients presents unique challenges due to growth and development.
- Congenital and acquired heart block necessitate long-term pacing solutions in children.
Purpose:
- To evaluate the long-term outcomes and complications of definitive pacemaker implantation in a pediatric cohort.
Summary:
- This study reviewed 27 children who received pacemakers between 1970 and 1988 for various forms of heart block.
- Indications included congenital auriculoventricular block, postoperative block, myocardiopathies, and sick-sinus syndrome.
- Epicardial implantation was more common (21 patients) than endocardial (6 patients). Reoperations occurred in 23 patients, mainly for battery failure (8) and device malfunction (4). Two deaths were recorded, one unrelated to the pacemaker and one due to electrode fracture.
- Despite reoperations, physical and mental growth and development were normal in the surviving children during an average follow-up of 55.6 months.
Impact:
- This research highlights the durability and safety of pacemakers in pediatric populations over extended periods.
- Findings inform clinical practice regarding the management of pediatric heart block and potential long-term device-related issues.
Abstract:
Definitive pacemakers were placed in 27 children from June 1970 to October 1988. The indication for the pacemakers was congenital auriculoventricular block in 12 patients who were symptomatic; 8 were children with postoperative auriculoventricular block; 4 had developed complete auriculoventricular block from myocardiopathies and 3 from idiopathic sick-sinus syndrome. Two patients died: one 4 months after placement of the pacemaker due to unrelated causes, and the other 14 years later due to fracture of the electrode. There were 23 who were reoperated for different reasons but the most frequent was battery failure in 8 patients and pacemaker malfunction in 4 patients. The electrode was implanted in the epicardium in 21 patients and via subclavian vein into the endocardium in 6 cases. The growth and development physically and mentally were normal during the follow-up of these children. The average follow-up period was 55.6 months.