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[Pacemaker implantation in 7 days or less old of early neonates]
Insights
Pacemaker implantation effectively treats neonates with congenital heart block and cardiac failure. Early intervention improves outcomes, though specialized device development is needed.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
Context:
- Congenital atrioventricular (AV) block can lead to severe, drug-resistant cardiac failure in neonates.
- Neonatal cardiac failure presents with rapid deterioration, ventricular tachycardia, or fibrillation.
Purpose:
- To evaluate the efficacy of cardiac pacemaker (PM) implantation in neonates with congenital AV block and advanced cardiac failure.
- To review existing literature on PM implantation in neonates and discuss key management aspects.
Summary:
- Cardiac pacemaker implantation was performed in 3 neonates (5 hours to 7 days old) with congenital complete/incomplete AV block and severe cardiac failure.
- Immediate improvement in cardiac function and long-term effectiveness (4 months to 2 years) were observed.
- A review of 14 neonates indicated that immediate PM implantation is the treatment of choice for neonatal cardiac failure due to congenital AV block.
Impact:
- Immediate pacemaker implantation is the preferred treatment for neonates with cardiac failure and congenital AV block.
- Current pacemaker generators and electrode designs require further development for optimal neonatal use.
- This study highlights the critical need for specialized pediatric cardiac pacing devices.
Abstract:
We have implanted cardiac pacemaker (PM) in 3 early neonates ranging from 5 hours old to 7 days old of age with congenital complete or incomplete AV block. They were in advanced stage of rapidly developed cardiac failure with resistance to drug therapy and with ventricular tachycardia or fibrillation. Cardiac failure was improved immediately in the 3 cases after the operation and the effectiveness by the pacing was recognized for a long term observation (4 months to 2 years). There appeared PM implantation in-14 neonates, including our cases, in Japanese literatures. In review of the 14 neonates, we discussed the autoimmune disease, indication of the pacing, implantation site of the PM generator and prognosis. An immediate PM implantation after birth in neonate with cardiac failure complicated by congenital AV block is treatment of choice. The generator as well as the electrode design for neonates are still yet to be developed.