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Permanent cardiac pacing in pediatric patients
Wael Lotfy1, Ranya Hegazy, Osama AbdElAziz
1Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Pediatric Cardiology
|August 14, 2012
Summary
Pediatric permanent pacemaker (PM) implantation is safe, with endocardial leads showing fewer complications than epicardial. Right ventricular pacing improved heart function in children with left ventricular dilation.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Medical Device Technology
Background:
- Pediatric pacemaker (PM) implants represent a small fraction (<1%) of all PM procedures.
- Understanding indications, complications, and optimal techniques for pediatric cardiac pacing is crucial.
- Previous research has not fully elucidated the impact of pacing sites and lead types in this population.
Purpose of the Study:
- To investigate permanent cardiac pacing in pediatric patients.
- To identify indications, complications, and outcomes associated with pediatric PM implantation.
- To evaluate the effect of pacing sites, lead type, and implantation route on outcomes.
Main Methods:
- A cross-sectional study of 103 pediatric patients undergoing permanent PM insertion from 2001-2010.
- Patients were followed for up to 6 months post-implantation, with clinical and device parameter evaluations.
- Data collected included patient demographics, pacing indications, implantation methods (transvenous endocardial vs. transthoracic epicardial), pacing sites, and complications.
Main Results:
- The most common indication was postoperative complete heart block (52.4%).
- Transvenous endocardial PM insertion (89.3%) was more common than transthoracic epicardial (10.7%).
- Right ventricular apex pacing was the most frequent site (62%). Epicardial insertion had higher complication rates.
- Endocardial pacing was associated with fewer complications and lower ventricular thresholds.
- 65% of patients with pre-existing left ventricular dilation showed improved LV dimensions and function with endocardial pacing.
Conclusions:
- Endocardial PM insertion in children is a safe and effective procedure with fewer complications compared to the epicardial route.
- Permanent single-chamber right ventricular pacing can safely improve left ventricular function and dimensions in select pediatric patients.
- Long-term follow-up is essential for a comprehensive evaluation of outcomes in pediatric cardiac pacing.
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