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Pacemakers in children: an update
1Department of Pediatrics, University of Nebraska Medical Center, Omaha68105.
Insights
Recent pacemaker technology offers improved options for pediatric patients. Pacemaker implantation is now recommended for specific congenital heart conditions, with advancements in leads and pacing modes enhancing treatment for children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Pediatric pacemaker indications have evolved since 1984.
- Congenital heart conditions necessitate updated pacing guidelines.
- Technological advancements are crucial for pediatric pacemaker use.
Purpose of the Study:
- Review recent pacemaker technological advances for infants, children, and adolescents.
- Discuss updated indications for pacemaker implantation in pediatric patients.
- Highlight new developments in lead technology and pacing modes.
Main Methods:
- Literature review of recent pacemaker technological advances.
- Analysis of current data on pacemaker implantation indications in children.
- Evaluation of new lead systems and pacing modes for pediatric use.
Main Results:
- Pacemaker implantation is indicated for asymptomatic congenital complete AV block, congenital AV block with long QT, and congenital long QT syndrome unresponsive to beta-blockers.
- Transvenous lead systems are increasingly feasible for pediatric use; epicardial lead improvements are needed for infants and cosmetic cases.
- Rate-responsive pacing is preferred for sinus node dysfunction and augmenting exercise tolerance; antitachycardia and atrial pacing features are valuable for tachyarrhythmias.
Conclusions:
- Pediatric pacemaker technology parallels adult advancements but requires specific considerations for young patients.
- Ongoing participation by pediatric cardiologists is essential for optimizing pacemaker systems in children.
- New pacemaker technologies offer improved management of bradyarrhythmias and tachyarrhythmias in pediatric populations.
Abstract:
This report reviews recent pacemaker technological advances as they apply to infants, children, and adolescents. Indications for pacemaker implantation in children have evolved since the 1984 Joint Task Force Guidelines. Recent data show that pacemaker implantation should be strongly considered in patients who have (1) asymptomatic congenital complete AV block with a mean heart rate less than 50 beats/min or other evidence of junctional instability; (2) congenital AV block with long QT interval; or (3) congenital long QT syndrome with bradyarrhythmias, or when conventional beta-blocker therapy is unsuccessful. Permanent pacemaker implantation is not necessarily an effective prophylactic measure against sudden death in patients following their operation who are receiving drug therapy for atrial tachyarrhythmias, and so is not absolutely indicated. New developments in lead technology have made transvenous lead systems more feasible for pediatric use. Because epicardial leads are required for small infants and for cosmetic reasons in some older children, design improvements are needed to enhance epicardial lead performance. Rate-responsive pacing is an acceptable alternative to dual-chamber pacing for augmenting exercise tolerance, and for children with sinus node dysfunction it is the preferred pacing mode. Pacemakers with automatic antitachycardia capabilities and with noninvasive electrophysiology features are valuable in children with atrial tachyarrhythmias. New data suggest that chronic atrial pacing also may be effective in controlling atrial tachyarrhythmias. New developments in pacemaker systems for the young parallel those for the older population, but differences between adult and pediatric patients demand ongoing increased participation by pediatric cardiologists.