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[Pacemaker implantations in children with regard to the site of implantation]
1Department of Cardiovascular Surgery, Hyogo Kenritsu Amagasaki Hospital, Japan.
Insights
Subaxillary implantation is recommended for pediatric pacemaker patients, especially infants, to minimize complications. Further development of reliable electrodes is crucial for improving long-term pacemaker therapy outcomes in children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Context:
- Permanent pacemaker implantation in children is a critical intervention for managing bradyarrhythmias.
- Evaluating long-term outcomes and surgical site complications is essential for optimizing device performance and patient safety.
Purpose:
- To assess the long-term results of permanent pacemaker implantation in a pediatric cohort.
- To identify the optimal generator pocket site and evaluate electrode types for improved outcomes.
Summary:
- This study reviewed 38 children (3 days to 15 years) undergoing permanent pacemaker implantation.
- Subaxillary generator pocket placement showed a lower complication rate (0%) compared to subcostal (4 skin necrosis, 3 lead fractures) and anterior chest (1 skin necrosis) sites.
- Epicardial electrodes had higher stimulation thresholds than endocardial ones; lower pacing rates are advised when feasible.
Impact:
- The findings support subaxillary implantation as the preferred site for pediatric pacemaker generator pockets, particularly in infants.
- Recommendations include optimizing pacing rates and highlight the need for more stable and reliable electrode technology for pediatric pacemaker therapy.
Abstract:
We reviewed thirty eight children, ranged 3 days to 15 years (mean, 7.2 years) of age, who underwent permanent pacemaker implantations in our hospital. Long-term results including the site of generator pocket were discussed. They are alive and well except two early and three late deaths that were not related to the pacemaker implantation. Twenty-seven epicardial and 11 endocardial electrodes were implanted at the initial operations. Thirteen pulse generators implanted in subaxillar position had no complications, otherwise, 12 subcostal implantation resulted 4 skin necrosis and 3 lead fractures. Eleven anterior chest implantations used for relatively older children resulted in one skin necrosis. We recommend subaxillar implantation for children, especially for small infants. The replacements of pulse generators due to battery depletion were done between 1.7 to 5.5 years (mean 4.0 years). Because epicardial implanted electrodes often show higher stimulation threshold than epicardial ones, pacing rate should be as lowered as possible if the patient had no symptom. Stab-in leads placed on the atrial wall sometimes caused the elevation of stimulation threshold and undersensing. We conclude that the development of more reliable and stable electrode is desired to improve the long term results of pacemaker therapy in children although the improvement of pulse generator itself and the operative procedure.