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VDD-pacemaker in children--a long-term therapy?
M Südkamp1, M Schmid, H-J Geissler
1Department of Cardiothoracic Surgery, University of Cologne, Cologne, Germany. michael.suedkamp@uk-koeln.de
Insights
Transvenous VDD pacemakers in children are a temporary solution for AV-synchrony. High reoperation rates due to lead tension suggest DDD pacing is better long-term.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Transvenous AV-synchronous pacing in pediatric patients utilizes VDD leads and miniaturized pacemakers.
- The long-term efficacy of this therapy in children has been a subject of ongoing investigation.
Purpose of the Study:
- To retrospectively evaluate the long-term outcomes of transvenous VDD pacing in children.
- To assess the safety and complication rates associated with VDD pacemaker implantation in pediatric patients.
Main Methods:
- A retrospective analysis of 104 children under 15 years old who received pacemakers between May 1977 and July 2001.
- Focus on 55 patients with transvenous leads, specifically the 12 who received VDD pacemakers for hemodynamic reasons.
Main Results:
- The mean follow-up period was 47.5 months, with VDD pacing functioning 86.3% of the time.
- Five out of twelve VDD patients (41.7%) required reoperation due to severe lead traction, necessitating explantation and conversion to dual-chamber pacemakers.
Conclusions:
- Perioperative implantation of VDD pacemakers in children is safe with a low initial complication rate.
- Significant lead tension requiring reoperation in 41.7% of VDD patients highlights potential long-term challenges.
- VDD pacing in younger children may serve as a temporary measure, bridging the need for AV-synchrony until conversion to DDD pacing in adulthood is feasible.
Aims:
Transvenous AV-synchronous pacing in children started with the invention of smaller sized VDD leads and miniaturization of pacemakers. Whether or not this is a favourable long-term therapy was retrospectively investigated by us based on data from our records.
Methods:
From May 1977 to July 2001 we implanted pacemakers in 104 children younger than 15 years of age. In 55 patients transvenous leads were implanted. Twelve of these (21.8 %) received a VDD pacemaker for hemodynamic reasons.
Results:
Ages ranged from 11 months to 14.5 years (mean 7.7 +/- 4.3 y). Sizes of the children ranged from 67 to 141 cm (mean 105.9 +/- 15.5 cm) and body weight ranged from 5.3 to 62.0 kg (mean 22.5 +/- 9.8 kg). The mean follow-up period was 47.5 +/- 15.1 months. In 86.3 % of the time during follow-up pacemakers of which we obtained data were working in the VDD mode. Five of the twelve VDD patients (41.7 %) had to be reoperated because of severe traction on the leads. In all five patients the VDD systems were explanted and the patients changed to dual chamber pacemakers. The period of time between implantation and VDD lead explantation ranged from 24 to 74 months (48.6 +/- 18.5).
Conclusions:
VDD pacemakers can be implanted safely even in children with a low complication rate perioperatively. 41.7 % of our VDD patients had to be reoperated within the surveillance time because of severe lead tension due to thoracic growth. In our experience VDD pacemakers in smaller children seem to be a temporary solution to bridge AV-synchrony from a young age to DDD pacing in young adulthood.
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