Related Experiment Videos
[Cardiac stimulation in children. A multicenter study of 241 patients]
Insights
This study evaluated cardiac pacing in 241 children, finding the myocardial approach effective, especially for younger patients, despite technical challenges. Long-term survival was good, with lithium batteries and VVI mode pacing common.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Context:
- Cardiac pacing in children presents unique challenges due to growth and anatomical differences.
- Atrioventricular block in children can be congenital or postoperative, necessitating pacing for conditions like syncope, bradycardia, and heart failure.
Purpose:
- To analyze the long-term results of cardiac pacing in a large cohort of pediatric patients.
- To evaluate the efficacy and complications of different pacing approaches (myocardial vs. endocavitary) and technologies in children.
Summary:
- A retrospective analysis of 241 children who underwent cardiac pacing between 1965 and 1982.
- The study details patient demographics, etiologies of heart block, pacing indications, implantation techniques, device specifics (lithium batteries, VVI mode), and complication rates.
- Myocardial pacing was favored in younger children, while endocavitary pacing was an alternative for older children, with overall good survival rates.
Impact:
- The findings support the continued use of myocardial pacing in pediatric populations, particularly infants and young children.
- Highlights the evolution of pacing technology, including the shift towards programmable pulse generators and lithium batteries.
- Provides valuable data on the long-term outcomes and challenges of pediatric cardiac pacing, informing clinical practice.
Abstract:
This study analyses the results of cardiac pacing in 241 children operated between 1965 and March 1982 in 9 french cardiac centres. The ages at primary implantation were: less than 5 years, 32.8 p. 100, 6 to 10 years, 33.6 p. 100 and 11 to 16.5 years, 33.6 p. 100. Atrioventricular block was congenital in 40.7 p. 100 of cases (98 children) and postoperative in 56.4 p. 100 (136 children) with 67 cases, after repair of isolated ventricular septal defect and 18 after repair of an endocardial cushion defect. The symptoms preceding pacing were syncope (67 cases), bradycardia (92 cases) and cardiac failure (33 cases). The electrocardiographic indications were third degree block in 66.8 p. 100 of cases. The pulse generators were usually implanted in the abdominal wall (71.8 p. 100). The power sources in service (August 1982) were lithium (74 p. 100) and isotopic batteries (26 p. 100). Myocardial electrodes were used in 93.4 p. 100 of cases; 82.2 p. 100 were made by Medtronic. Early problems included: infection (10 cases), displacement of endocavitary electrodes (3 cases), elevated thresholds (2 cases). The late problems encountered were due to fracture of the pacing electrodes (19 cases) and elevated thresholds (50 cases). Two hundred and seven children are alive and well. A total of 341 pulse generators were implanted, 90 p. 100 being VVI mode. In August 1982, 56.6 p. 100 were programmable or multiprogrammable. Despite the technical problems involved, the myocardial approach is still used with good results, especially in young children and babies. The endocavitary approach is an alternative after 5 years of age.(ABSTRACT TRUNCATED AT 250 WORDS)