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Antitachycardia pacemaker treatment of postoperative arrhythmias in pediatric patients
J Fukushige1, C B Porter, D L Hayes
1Section of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905.
Insights
An automatic antitachycardia pulse generator effectively treated drug-resistant supraventricular arrhythmias in pediatric patients. This pacemaker reduced drug therapy and hospital admissions, proving valuable despite technical challenges.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Persistent postoperative supraventricular arrhythmias in pediatric patients often prove resistant to drug therapy.
- Congenital heart disease surgical repairs (e.g., Mustard, Senning, Fontan procedures) can lead to complex arrhythmias.
- Drug-resistant arrhythmias necessitate alternative treatment strategies in pediatric populations.
Observation:
- Six pediatric patients (mean age 10 years) with refractory supraventricular arrhythmias received an automatic antitachycardia pulse generator (Intertach 262-12).
- Patients had histories of complex congenital heart disease and prior surgical interventions.
- Follow-up averaged 31 months, during which pacemakers activated appropriately multiple times.
Findings:
- The antitachycardia pacemakers functioned appropriately in all six patients.
- Complications occurred in three patients, requiring six interventions (system erosion/infection, adaptor/connector fracture, lead dislodgement).
- All patients experienced reduced drug therapy, with one on digoxin alone; hospital admissions decreased post-implantation.
Implications:
- Multiprogrammable antitachycardia pacemakers are a valuable therapeutic option for pediatric patients with refractory postoperative supraventricular tachyarrhythmias.
- While technical challenges exist, device implantation can lead to improved arrhythmia management and reduced medication burden.
- Further research into optimizing device placement and management strategies may mitigate complications and enhance long-term outcomes.
Abstract:
An automatic antitachycardia pulse generator (Intertach 262-12) was implanted in each of six pediatric patients (mean age, 10 years) with drug-resistant and persistent postoperative supraventricular arrhythmias. Four had bradycardia-tachycardia syndrome, two after a Mustard procedure for transposition of the great arteries, one after a Senning procedure for the same anomaly, and one after a Fontan procedure for univentricular heart with transposition of the great arteries. Of the two remaining patients, one had atrial flutter after a modified Fontan procedure for univentricular heart and one had intra-atrial reentry tachycardia after a modified Fontan procedure for double-outlet right ventricle with pulmonary stenosis. During a mean follow-up interval of 31 months after implantation, pacemakers were activated on multiple occasions and functioned appropriately in all six patients. Complications necessitated six invasive interventions in three patients: erosion or infection of the system, adaptor fracture, and connector block fracture on one occasion each and lead dislodgment on three occasions. Four of the six patients continued to take drugs at the end of this study; however, all patients had their drug therapy reduced and one was taking digoxin only. The number of hospital admissions decreased after implantation. Despite a number of technical challenges, this newer multiprogrammable antitachycardia pacemaker appears to be a valuable addition to the treatment of refractory postoperative supraventricular tachyarrhythmias in pediatric patients.