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Permanent cardiac pacing in children: morbidity and efficacy of follow-up
M W Kerstjens-Frederikse1, M T Bink-Boelkens, M J de Jongste
1Division of Paediatric Cardiology, University of Groningen, The Netherlands.
Insights
Pediatric pacemaker systems have a 5-year survival of 48%, with lead issues causing most complications. Endocardial leads are recommended from age 5 for better outcomes in children requiring permanent pacing.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Permanent pacing in children is crucial for managing cardiac conditions.
- Pacemaker system longevity and complication rates are significant concerns in pediatric patients.
Purpose of the Study:
- To review complications and follow-up efficacy in permanently paced children.
- To evaluate patient and system survival rates.
- To identify causes of pacemaker system failures and surgical interventions.
Main Methods:
- Retrospective review of data from 50 permanently paced children.
- Analysis of patient and pacing system survival over a mean follow-up of 5.3 years.
- Categorization of complications, focusing on lead-related issues and surgical intervention causes.
Main Results:
- Five-year patient survival was 78%, with mortality linked to underlying cardiac disease.
- Five-year pacing system survival was 48%, with surgical interventions needed every 4.9 patient years.
- Lead-related problems caused 58% of surgical interventions; epicardial leads had more exit blocks and high thresholds than endocardial leads.
Conclusions:
- Endocardial leads are recommended for pediatric patients from age 5 onwards due to better performance than epicardial leads.
- Pacemakers with high output facilities are necessary if epicardial leads are used.
- Frequent transtelephonic monitoring in the first 3 months post-implantation and regular Holter monitoring are suggested to detect complications early.
Abstract:
The data from 50 permanently paced children [mean standard deviation follow-up 5.3 +/- 3.7 years] were reviewed, with special attention being paid to the cause of complications and the efficacy of follow-up. The 5-year survival (SD) of the patients was 78 +/- 6%; mortality was mainly due to the underlying cardiac disease. The 5-year survival (SD) of the pacing systems was 48 +/- 8%. Surgical interventions were necessary every 4.9 patient years. Of these interventions, 58% were caused by lead-related problems. Epicardial leads showed significantly more exit blocks and high thresholds than endocardial leads. Endocardial leads, therefore, should be used at a younger age than is now the current practice, from 5 years of age onwards, for example. If epicardial leads are used, the pacemaker must have a high output facility. Since exit block occurred only within the first 3 months after implantation, we suggest frequent transtelephonic monitoring during the first 3 months. Holter monitoring appeared to be the most effective and sensitive method of detecting malsensing and should be performed regularly.