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[Standards in pediatric pacemaker therapy]
H Antretter1, M Fritz, J Bonatti
1Abteilung für Herzchirurgie, I. Chirurgische Universitätsklinik, Innsbruck.
Insights
Pediatric pacemaker implantation requires special care due to patient size and complex cardiac conditions. Careful system selection and management are crucial for successful long-term pacing in children.
Area of Science:
- Pediatric Cardiology
- Biomedical Engineering
Background:
- Pediatric pacemaker implantation presents unique challenges compared to adults, including smaller patient anatomy and frequent complex congenital heart defects.
- The availability of pediatric-specific pacing hardware remains limited, necessitating careful selection of existing systems.
Purpose of the Study:
- To review current standards and guidelines for surgical pacemaker therapy in pediatric patients.
- To discuss strategies for preventing complications associated with pacemaker implantation and management in children.
Main Methods:
- Retrospective review of 18 pediatric patients undergoing permanent pacemaker implantation.
- Analysis of patient demographics, indications for pacing, implantation techniques, system revisions, and pulse generator longevity.
Main Results:
- The study included 18 pediatric patients with a mean age of 11.5 years, with indications including surgically induced heart block (50%), congenital complete heart block (33.3%), and sick sinus syndrome (16.7%).
- A significant proportion (72.2%) required pacing system revisions, with a mean pulse generator longevity of 36.8 months.
- Initial implantations often utilized epicardial electrodes (72.2%), with later upgrades to dual-chamber pacing occurring at a mean age of 9.0 years.
Conclusions:
- Pediatric pacemaker therapy demands tailored approaches, considering patient-specific factors and the need for potential system upgrades.
- Effective management strategies are essential to minimize complications and optimize long-term pacing outcomes in children.
Abstract:
Despite differences between pediatric and adult pacing have narrowed, implantation procedures in children require special considerations. Patients are physically smaller, they often suffer from complex cardiac defects necessitating further open heart surgery procedures. As there are no pacemakers and only some electrodes designed specially for pediatric pacing, selection of appropriate systems is important. At this time we care for 18 patients with a mean age of 11.5 +/- 6.5 years (= 138.6 +/- 78.4 months, range 10 to 280 months). 50% of them received a permanent pacemaker because of surgically induced heart block, 33.3% because of congenital complete heart block and 16.7% because of sick sinus syndrome. Mean age at first pacemaker implantation was 57 +/- 42 months (Range 0 to 120 months). 72.2% of these children had their first pacing system implanted in the abdominal wall with an epicardial electrode, 27.8% had endovenous endocardial electrodes with subpectoral generator placement. 72.2% of our patients had already revisions of their pacing systems, mean longevity time of pulse generators were 36.8 +/- 21.8 months. Upgrading from single chamber pacing to physiological AV-sequential dual chamber pacing was performed at a mean age of 9.0 +/- 2.8 years (= 108.3 +/- 33.9 months, range 66 to 154 months). By reviewing our patient data we want to discuss present standards and guidelines of surgical pacemaker therapy in children and how to prevent potential complications.