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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.
Insights
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.
Abstract:
Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow-up assessment is needed for further evaluation.
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