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[Pacemaker therapy in children]
G Brüggemann1, E Steil, H Barth
1Abt. f. pädiatrische Kardiologie der Univ.-Kinderklinik Tübingen.
Insights
Pediatric patients receiving permanent pacemaker (PM) implants showed a significant increase in the interval between revisions over time. This improvement is attributed to the predominant use of epicardial leads in pacemaker procedures for children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
- Electrophysiology
Context:
- Study period: 1975-1987, involving 55 pediatric patients.
- Age range at implantation: 1 month to 17.5 years (mean 5.4 years).
- Pacemaker type: VVI-PM exclusively implanted.
Purpose:
- To evaluate the long-term outcomes and revision rates of permanent pacemaker (PM) implantation in pediatric patients.
- To assess the impact of lead type (epicardial vs. transvenous) on PM revision frequency.
- To analyze trends in revision intervals over the study period.
Summary:
- 84% of implantations were for post-surgical bradyarrhythmia; 16% for congenital or acquired conduction system disturbances.
- A total of 20 revisions were performed across 14 children over 2603 months of follow-up.
- Electrode failure was the cause in 50% of revisions; however, the mean interval between revisions increased significantly to 130 months.
Impact:
- The study highlights a significant improvement in pacemaker reliability in pediatric patients over time.
- The exclusive use of epicardial screw-in electrodes is strongly associated with a lower incidence of revisions.
- Findings support the use of epicardial leads for long-term pacemaker function in pediatric populations.
Abstract:
Between 1975 and June 1987 55 children underwent first permanent pacemaker (PM) implantation. The patients' age at time of implantation ranged between 1 month and 17 1/2 years (mean 5 5/12 years). In all cases - except a 17 years old girl who received a transvenous endocardial lead - only epicardial screw-in electrodes were used. Only VVI-PM have been implanted. In 84% the indication for implantation was post-surgical brady-arrhythmia, in 16% it was an inborn or acquired disturbance of the conducting system. With our patients we have a survey of 2603 months of PM implantation. During this period 14 children underwent totally 20 revisions, in 50% the electrode was the cause of failure. The interval between two revisions calculated as a quotient from months of PM implantation and number of revisions has increased significantly during the last years and amounts now to 130 months. The relative low incidence of revisions is in our opinion mostly related to the nearly exclusive use of epicardial leads.