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Permanent cardiac pacing in pediatrics: experience in Thailand.
Jarupim Soongswang1, Apichart Nana, Duangmanee Laohaprasittiporn
1Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Mahidol University, Bangkoknoi, Bangkok, Thailand. sijsw@mahidol.ac.th
Summary
Permanent pacemaker implantation in children is rare but feasible and safe. Pacing parameters remained stable long-term, with epicardial leads showing higher energy thresholds but similar failure rates to endocardial leads.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Permanent cardiac pacing in pediatric patients is uncommon, with limited data available from Thailand.
- Atrio-ventricular block was the primary indication for pacemaker implantation in all studied patients.
- Etiologies for pacing included post-cardiac surgery, maternal autoimmune diseases, post-radiofrequency ablation, and unknown causes.
Purpose of the Study:
- To evaluate the outcomes of permanent pacemaker implantation in pediatric patients at Siriraj Hospital.
- To analyze pacing parameters and complication rates during follow-up periods.
- To compare the performance of epicardial versus endocardial lead approaches.
Main Methods:
- A retrospective study of 31 pediatric patients who underwent permanent pacemaker implantation between January 1997 and December 2004.
- Data collection included cardiac data, pacing parameters, implantation methods (epicardial vs. endocardial), and follow-up information.
- Statistical analysis was performed to compare patient characteristics, pacing parameters, and lead performance.
Main Results:
- The incidence of permanent pacemaker implantation was low (4.4 cases/year).
- Epicardial approach was used in 74.2% of cases, predominantly in younger patients with smaller body sizes.
- No significant changes in pacing parameters (energy threshold, sensitivity, impedance) were observed during medium-term follow-up for either lead type, though epicardial leads had a higher minimum energy threshold.
Conclusions:
- Permanent pacemaker implantation in children is a feasible and relatively safe procedure, adaptable to various body sizes.
- Both epicardial and endocardial leads demonstrated stable pacing parameters at medium-term follow-up.
- While epicardial leads required a higher minimum energy threshold, lead survival rates were comparable between epicardial and endocardial approaches.