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Transvenous cardiac pacing in children: problems and complications during follow-up
Alpay Celiker1, Osman Başpinar, Tevfik Karagöz
1Department of Pediatric Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Pediatric transvenous permanent cardiac pacing (TPCP) is safe and effective. While complications can occur, requiring potential lead or generator revisions, long-term outcomes for children receiving TPCP are favorable.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Devices
Background:
- Transvenous permanent cardiac pacing (TPCP) is a common treatment for pediatric heart rhythm disorders.
- Understanding the outcomes and potential complications of TPCP in children is crucial for clinical practice.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric transvenous permanent cardiac pacing.
- To identify the types and frequency of problems and complications associated with pediatric TPCP.
Main Methods:
- Retrospective review of 155 pediatric patients who underwent TPCP implantation between 1993 and 2003.
- Analysis of indications for pacing, implantation techniques, pacemaker settings, lead characteristics, and follow-up data.
- Kaplan Meier analysis was used to assess lead survival.
Main Results:
- 29% of patients experienced complications, including 21 minor and 45 major events.
- Lead dislodgement and stretching were the most common lead problems, necessitating revisions in 44 of 76 cases.
- Despite complications, lead survival did not differ significantly between lead types, and long-term outcomes were favorable with three sudden unexpected deaths.
Conclusions:
- Transvenous permanent cardiac pacing is a safe and effective therapeutic option for children.
- Complications can occur, and lead or generator revisions may be required.
- The long-term prognosis for pediatric patients undergoing TPCP is generally favorable.
Objective:
Transvenous permanent cardiac pacing (TPCP) has become a frequently used therapeutic modality in children. The purpose of this study was to evaluate the outcome of pediatric TPCP regarding problems and complications.
Methods:
Records of 155 patients (mean age 9.2+/-4.7 years) who underwent implantation of TPCP between 1993 and 2003 were reviewed retrospectively. Indications for pacing included atrioventricular block in 76% and sinus node dysfunction in 22% patients. In 92 patients, bradyarrhythmia was secondary to cardiac surgery. Percutaneous subclavian puncture was used for lead implantation in 96% of patients. Pacemakers were placed to the right side of the chest in 84% and in the subpectoral area in 68%. Pacing modes were VVIR in 72%, VDD in 13%, AAIR in 8%, and DDD in 7% of patients at the initial implantation time. Of all electrodes, 95% had steroid elution and 53% had an active fixation mechanism. Mean follow-up period was 37+/-28 (1-120) months.
Results:
Forty-five (29%) patients had 21 minor and 45 major complications. Forty-four of 76 revisions were due to lead problems and battery extraction. Most of the lead problems were dislodgment and stretching (n=14). Kaplan Meier analysis of lead survival did not show any difference between lead types. During the follow-up, there were three sudden unexpected deaths.
Conclusions:
In children, TPCP can be used safely and effectively. Although, complications are possible and sometimes lead or generator revision may be necessary, long-term outcome is favorable.
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