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Pediatric pacemaker implantation showed significant lead malfunction rates, impacting long-term outcomes. Future improvements in pacing technology and techniques are crucial for better results in children requiring pacemakers.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Permanent pacemaker implantation in children presents unique challenges.
- Early pacemaker systems had limitations affecting pediatric patient outcomes.
Purpose of the Study:
- To review the early experience of permanent pacemaker implantation in a pediatric population.
- To identify complications and assess outcomes in children with pacemakers.
Main Methods:
- Retrospective review of 14 pediatric patients who received permanent pacemakers between 1967 and 1983.
- Analysis of indications for pacing, device types, lead systems, and complications.
Main Results:
- Nine patients had postoperative complete heart block, three congenital complete heart block, and two sick sinus syndrome.
- Lead system malfunction occurred in 7 of 14 patients, with 20 lead malfunctions in total.
- Two patient deaths occurred, one sudden and one post-aortic valve replacement.
Conclusions:
- Early pediatric pacemaker implantation faced significant challenges, particularly with lead reliability.
- Despite complications, psychological and physical development appeared normal in the surviving children.
- Advancements in pacemaker technology and surgical techniques are essential for improving the prognosis of pediatric patients requiring permanent pacing.
Abstract:
Fourteen children had a permanent pacemaker implanted between May 1967 and July 1983. Postoperative complete heart block was the indication in nine cases, congenital complete heart block in three, and sick sinus syndrome in two. Two patients died, one suddenly and one after aortic valve replacement. A total of 48 pulse generators were implanted; five patients were given an isotopic pacemaker. Twelve patients had epicardial leads implanted initially, and two received a transvenous endocardial system. The lead system implanted initially remained without malfunction in only seven patients. In the other seven patients 20 lead malfunctions occurred. Psychological maturity and physical development seemed to be normal in all 14 children. Improvement in equipment and technique will improve the outlook for paced children in the future.