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Pacemaker implantation in children: a 21-year experience
C A Walsh1, H F McAlister, C A Andrews
1Department of Pediatrics, Montefiore Medical Center, Bronx, New York 10467.
Insights
This study followed 41 children with pacemakers for an average of 90 months, finding improved pacemaker technology and reduced hospitalization intervals over time. Long-term outcomes show a transition towards dual-chamber and rate-modulated devices in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Pacemaker implantation in children is necessary for various congenital and acquired heart conditions.
- Technological advancements in pacemakers have evolved significantly since the 1960s.
- Long-term outcomes and complication rates in pediatric pacemaker recipients require ongoing evaluation.
Purpose of the Study:
- To evaluate the long-term outcomes of pacemaker implantation in a pediatric population.
- To assess the evolution of pacemaker technology and implantation techniques in children over three decades.
- To analyze complication rates, mortality, and functional status of pediatric patients with pacemakers.
Main Methods:
- Retrospective analysis of 41 pediatric patients (11 days to 19 years) who received pacemakers between 1966 and 1988.
- Patients were divided into three groups based on implantation period (1966-1972, 1973-1980, 1981-1988).
- Data collected included patient demographics, underlying arrhythmias, pacemaker type, implantation site, complications, and functional status at follow-up.
Main Results:
- The study observed a trend towards transvenous implantation (increasing from 40% to 82%) and the use of dual-chamber and rate-modulated pacemakers over time.
- The average interval between pacemaker-related hospitalizations increased from 20 months in Group I to 42 months in Group II and 39 months in Group III.
- Complications included infection (6), hemothorax (1), and impending pacemaker erosion (1). Six patients died, primarily from cardiac disease.
Conclusions:
- Pediatric pacemaker technology and implantation methods have advanced, leading to improved outcomes and reduced hospitalization frequency.
- Despite advancements, significant complications and mortality remain, emphasizing the need for careful patient selection and monitoring.
- Long-term follow-up indicates that many pediatric pacemaker recipients can achieve a good functional status and participate in daily activities.
Abstract:
Forty-one children, 20 boys and 21 girls, aged 11 days to 19 years (mean 9.9 years) at initial pacemaker implant, were followed 1 to 248 months (mean 90 months). Ten (mean age 8.2 years) were implanted between 1966 and 1972 (Group I), 14 (mean age 9.9 years) between 1973 and 1980 (Group II) and 17 (mean age 10.9 years) from 1981 through April 1988 (Group III). Arrhythmias were congenital complete heart block in 19, postoperative heart block in 15, acquired heart block in 3, sick sinus syndrome in 3, and bradycardia-induced ventricular fibrillation in 1. Twenty-eight of 41 children had a transvenous implant: 40% of Group I, 71% of Group II and 82% of Group III. Thirteen were cephalic, four subclavian and 11 jugular. Generator site was pectoral in 19, abdominal in 12, intrathoracic in one, and retromammary in nine of 12 girls aged 10 years or more at implant. In Groups I, II and III, 5, 14 and 6 had VOO or VVI units; 5, 0 and 8 dual chamber (VAT, VDD and DDD) pacemakers; 0, 0 and 1 AAI; and 0, 0 and 2 rate-modulated (VVIR) units at initial implant. The average interval between pacer-related hospitalizations in Groups I, II and III was 20, 42, and 39 months. Complications included infection in six, hemothorax in one, and impending pacemaker erosion in one. Six patients died, one of pacer infection, four from primary cardiac disease, and one suddenly without apparent reason. Follow-up continues in 31: 14 are employed full-time, three are homemakers, eight are full-time students, and six are active pre-schoolers.(ABSTRACT TRUNCATED AT 250 WORDS)