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Fourteen years of implanted pacemakers in children
Insights
Pediatric pacemaker patients show long-term electrode survival. However, pulse generator longevity varies, and sudden deaths highlight the need for advanced pacing technology in children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Long-term follow-up of pediatric patients with permanent pacemakers is crucial for understanding device performance and patient outcomes.
- This study evaluates outcomes in 26 children implanted with pacemakers at a young age, covering various etiologies of bradycardia.
Observation:
- High survival rate of original pacemaker electrodes, with 69% of patients still using them after extended follow-up (up to 163 months).
- Significant variability in pulse generator longevity, averaging 17 months, with a range of 1 to 55 months.
- Mortality rate of 19% (5 out of 26 patients), with three deaths due to underlying heart disease and two sudden unexplained deaths.
Findings:
- Original pacemaker electrodes demonstrate excellent long-term durability in pediatric patients.
- Pulse generator lifespan is highly variable, necessitating careful consideration of replacement schedules.
- Two sudden unexplained deaths occurred in patients with fixed-rate pulse generators, suggesting potential risks associated with certain pacing modes in susceptible individuals.
Implications:
- The findings underscore the importance of selecting appropriate pacing technology, including synchronized and demand pacing, to minimize risks like sudden cardiac death in pediatric populations.
- Advances in pacemaker technology, such as lithium-powered and nuclear-powered generators, may offer improved longevity and safety profiles.
- Continued research into optimal pacemaker selection and management strategies is vital for improving long-term outcomes in children with pacemakers.
Abstract:
Twenty-six children who had permanent pacemakers implanted at 6 hours to 11 years of age have been followed for up to 163 months. There were 14 children with surgical heart block, 9 with congenital heart block, 2 with postcatheterization complete heart block, and 1 with bradytachydysrhythmia syndrome. Eighteen of the 26 patients (69%) are still being paced with their original electrodes, some for more than eight years. Sixty pulse generators lasted an average of 17 months (range, 1 to 55 months). Five of the 26 patients (19%) are dead. Three died of noncorrectable heart disease, but there were 2 sudden unexplained deaths at home, both apparently due to sudden arrhtthmias. Both of these patients had received fixed-rate pulse generators, and 1 had a known potential for competing rhythms. The current optimal choices of equipment and techniques, including the role of synchronized, demand, lithium-powered, and nuclear-powered pulse generators, are discussed.