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Changing indications for pacemakers in children
Insights
Pediatric permanent pacemaker use has shifted towards sinus node dysfunction, with newer lithium devices offering superior longevity compared to older mercury-cell generators.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Permanent pacemakers are implanted in children for various cardiac conditions.
- Historically, surgical and congenital heart block were common indications.
Purpose of the Study:
- To analyze the changing indications for permanent pacemaker implantation in children.
- To evaluate the performance and longevity of different pacemaker pulse generators in pediatric patients.
Main Methods:
- Retrospective review of 50 pediatric patients who received permanent pacemakers.
- Analysis of implantation indications, patient demographics, and follow-up data.
- Comparison of electrode issues and pulse generator survival rates between mercury-cell and lithium-powered units.
Main Results:
- Symptomatic sinus node dysfunction (SND) was the primary indication (68%), often in patients with prior cardiac surgery.
- Electrode problems were infrequent (8%).
- Lithium-powered pacemakers demonstrated superior longevity and satisfactory pacing in survivors compared to mercury-cell generators.
Conclusions:
- Indications for pediatric cardiac pacing have evolved, with SND becoming the predominant reason.
- Modern pacemaker technology, particularly lithium batteries, offers improved reliability and longer functional life in children.
- Surgical block is now a less frequent indication for pacing in the pediatric population.
Abstract:
Permanent pacemakers were implanted in 50 children. Indications were symptomatic sinus node dysfunction in 34 (68%), surgical block in 9 (18%), and congenital block in 7 (14%). Twenty-three (68%) of the 34 children with sinus node dysfunction had undergone prior cardiac operations. Only 4 of the 50 patients (8%) had electrode problems after a mean pacing time of 29.5 months (range, 1 to 96 months). All 35 of the mercury-cell pulse generators used in 28 patients ceased to function after an average useful life of 20.8 months (range, 1 to 51 months). The lithium-powered units in the 45 survivors all show satisfactory pacing after 5 to 44 months (mean, 28.1 months). With improved pacemaker technology, longer survival after complex repairs, and better monitoring techniques, the indications for cardiac pacing in children have broadened. Surgical block now is an indication in only a small fraction of the pediatric pacemaker population. Sinus node dysfunction accounts for an ever-increasing majority of the pacemakers we currently implant in children.