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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.
Pacing and Clinical Electrophysiology : PACE
|November 1, 1988
Summary
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.