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Clinical experience of pacemaker treatment in children
R Nordlander1, S K Pehrsson, K Böök
1Department of Cardiology, Karolinska Hospital, Stockholm, Sweden.
Insights
Pediatric pacemaker implantation faces challenges, primarily due to electrode issues. Endocardial pacing is recommended over epicardial leads for children, even infants, due to a significantly lower reoperation rate.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Implantable Devices
Background:
- Pacemaker treatment in children presents unique complexities compared to adults.
- Electrode-related complications are a primary concern in pediatric pacemaker systems.
Purpose of the Study:
- To evaluate the long-term outcomes and complications of pacemaker systems in pediatric patients.
- To compare the efficacy and safety of epicardial versus endocardial electrodes in children.
Main Methods:
- A retrospective analysis of 23 children (aged 2 days to 14 years) who received pacemaker systems since 1983.
- Initial implantation involved either epicardial (10 cases) or endocardial (13 cases) electrodes.
- Tracking of reoperations, reasons for reoperation, and electrode type.
Main Results:
- Eight out of ten epicardial electrodes required replacement with endocardial leads within a mean of 2.5 years.
- A high reoperation rate (18 total) was observed, predominantly linked to epicardial leads (8 cases) due to increased threshold/exit block.
- Other reoperation reasons included electrode failure, body growth-related stretching, and infection.
Conclusions:
- The reoperation rate associated with epicardial pacemaker electrodes in children is unacceptably high.
- Endocardial pacing is identified as the preferred method for pediatric pacemaker implantation, including for very young infants.
Abstract:
Pacemaker treatment is more complicated in children than in adults, mainly because of electrode problems. A pacemaker system was implanted in 23 children aged 2 days-14 years (mean 4.8 years, with 11 less than or equal to 3 years) at the Karolinska Hospital since 1983. The indications for pacing were peroperative atrioventricular block (AVB) in 13 cases, congenital AVB in five, sinoatrial disorder in four and slow ventricular arrhythmia in one case. The initially implanted electrode was epicardial in ten children (in the first 2 years of the study) and endocardial in the other 13. Eight of the ten epicardial electrodes had to be replaced by endocardial within a mean of 2.5 years. There were 18 reoperations, the reasons being increased threshold/exit block--all epicardial leads (8 cases), electrode failure (1), 'stretching' of the electrode secondary to body growth (4), local infection (3) and generator replacement (2). The reoperation rate was unacceptably high in children with epicardial electrodes. Endocardial pacing is the method of choice even for small infants.