Implantation of a leadless pacemaker in a pediatric patient with congenital heart disease (original) (raw)
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Pacemaker system failure and other events in children with surgically induced heart block
Pacing and clinical electrophysiology : PACE, 1988
Of 1,193 consecutive pediatric (less than 18 years) patients undergoing intracardiac repair from 1975 to 1984, 38 (3.2%) developed surgically induced complete heart block and were treated by permanent pacemaker implantation. Anomalies included complete atrioventricular septal defect = 9 (24%), simple ventricular septal defect = 9 (24%), atrioventricular discordant connection = 8 (212), tetralogy of Fallot = 7 (182), and other complex anomalies = 5 (13%). There were no hospital deaths. follow-up was 100% complete. There were six late deaths = 16%. Actuarial survival was 79 + 9% at 10 years. None of the late deaths were related to disturbance of cardiac rhythm or pacemaker system failure. Twelve patients (32%), required 27 reoperations for various types of pacemaker system failure. Indications for reoperation included: lead failure (44%). Pulse generator failure (44%), and wound sepsis (12%). Actuarial freedom from any pacemaker related reoperation was 50 + 16% at 48 months and 25 + 1...
Heart Rhythm, 2006
After half a century of major progress in congenital heart disease management, atrioventricular conduction block continues to complicate 1-3% of surgical procedures. Unless treated with an implanted pacemaker, permanent postoperative heart block is associated with 28 -100% mortality. Postoperative heart block often proves to be transient, typically resolving within 10 days of onset. The duration of postoperative heart block is widely used as a key determinant for permanent pacemaker implantation. Current professional pacemaker implantation guidelines are largely based on this criterion. However, available natural history data suggest that other factors, such as residual conduction system injury, likely play a role in increasingly recognized cases of very late postoperative mortality and morbidity in patients who have experienced transient postoperative heart block. As growing numbers of congenital heart disease patients survive into adulthood, and artificial pacemaking capabilities continue to improve, it might be necessary to reconsider and refine currently accepted pacing indications for postoperative heart block.
Outcomes of pacemaker implantation in isolated congenital atrioventricular block
Progress in Pediatric Cardiology, 2020
Background: Most patients with isolated congenital atrioventricular block will eventually require a pacemaker implantation at an early age. Aims: To document a single-center experience of all patients with pacemaker implantation secondary to isolated congenital atrioventricular block. Methods: A retrospective review of all patients with isolated congenital atrioventricular block and pacemaker implantation over a period of 11 years was conducted. All patients were identified by using a surgical database. Descriptive statistics were mainly used. Results: Eighteen patients met the inclusion criteria. The median follow-up time, gestational age, and birth weight were 3.8 years, 35 weeks, and 2.1 kg, respectively. Eleven patients were born to mothers with autoimmune disease (61%). The median age at the time of initial implantation, initial generator longevity, and hospital stay per intervention were 5 days, 5 years, and 7 days, respectively. All patients had epicardial pacing except for one patient, who had a transvenous system. Among the 18 patients, initial implants consisted of 13 single-chamber, three dual-chamber, and two with temporary pacing only. Two patients underwent an upgrade to a biventricular system due to associated dilated cardiomyopathy without response. To date, all initially implanted leads are functional except for four leads. Four patients died due to extreme prematurity and from complications of dilated cardiomyopathy. Conclusion: Isolated congenital atrioventricular block is associated with significant mortality, especially when associated with dilated cardiomyopathy. Baseline left bundle branch block escape rhythm was noted to be present in most patients with dilated cardiomyopathy. Overall, lead performance and battery longevity were excellent. However, transvenous-type temporary pacing was associated with significant complications.
VDD Pacing in Children with Congenital Complete Heart Block: Advantages of a Single Pass Lead
Pace-pacing and Clinical Electrophysiology, 1997
A single pass lead for VDD pacing in complete heart hlock is well descrihed in adults hut there are only brief reports of its use in children. We used standard adult size single pass leads in ten children and adolescents aged 3.7–17.2 years (mean 9.9 years) and weighing 13.5–76 kg (mean 35.4 kg) with congenital complete heart block. One patient had coexisting congenital heart disease and had undergone surgery. A 2:1 atrioventricular hlock in one patient was presumed to he congenital in origin. In four patients, the VDD system was their first pacing system. In six of the patients, 1–4 previous systems had been used and simultaneous extraction of ventricular leads (6) and/or atrial leads (2) was performed. Four different types of lead were used: Brilliant IMP15Q (Vitatron); Brilliant + IMR15Q (Vitatron): Cap-Sure 5032 (Medtronic); and Unipass 425–13 (Intermedics) witb four different generators: Saphir 600 (Vitatron): Saphir II 620 (Vitatron): Thera VDD 8948 (Medtronic): and Unity 292–07 (Intermedics). All leads were introduced via a suhclavian vein puncture and the atrial dipole was placed low in the right atrium to provide slack for further growth while maintaining atrial sensing. Ventricular thresholds ranged from 0.2–0.8 V. The minimal atrial amplitude was 0.7–4 mV and the maximum amplitude was 2.5–8 mV. There was one early microdisplacement and the lead was repositioned. Over a follow-up period ranging from 1–39 months (mean 20.4 months), all patients have maintained low ventricular pacing thresholds and adequate atrial signals for reliable pacing at rest and with exercise. During this time some bave undergone considerahle growth. The patient with coexisting congenital heart disease died suddenly at 3 years, hut the pacing system had no fault at autopsy. The standard adult size single pass lead provides a simple means to enable reliahle atrial synchronous ventricular pacing in growing children with complete heart hlock.
Europace, 2002
Aims This study assessed survival, morbidity and impact of pacemaker (PM) therapy in children with Congenital Complete Atrioventricular Block (CCAVB). Methods and Results Data of 32 children, diagnosed as showing CCAVB at a median age of 0•4 years (range foetal-10 years), were retrospectively analysed. For comparison of clinical data patients were separated into two groups: CCAVB without structural heart disease (group 1; n=23) and with structural heart disease (group 2; n=9). Median follow-up time was 10•2 years. Pacemakers (PM) were implanted in 17 group 1 and all group 2 children. Frequency of PM therapy, age and symptoms before PM implantation did not differ significantly between the groups. Indications for PM implantation were bradycardia in 15, decreased exercise tolerance in 6, syncope in 3 and heart failure in 2 children. PM system related complications occurred in 11/26 (42%) children. Although 1 child died due to PM exit block no further CCAVB related symptoms were recorded in children with PM. Conclusion PM therapy reduces mortality and morbidity in children with CCAVB when compared with natural history data. Although children with PM are free from CCAVB related symptoms limited morbidity remains due to PM system related complications.
Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial?
Europace, 2013
Cardiac pacing is a difficult technique in children, particularly in patients with congenital heart defects (CHDs). Few studies to date have addressed this topic. We performed a retrospective analysis of the results of a single centre. Between 1982 and 2008, 287 patients with CHD, median age of 5 years (25-75%, 1-11) underwent cardiac pacing for sinus node dysfunction (SND) and atrioventricular block (AVB); 97% of patients underwent at least one heart surgery. Endocardial systems (Endo) were implanted in 117 patients, epicardial systems (Epi) in 170, with 595 leads (228 Endo, 367 Epi). Endocardial systems showed a significantly older age group with more frequent SND; Epi a younger age group, with more frequent AVB, greater number of surgical interventions. Perioperative complications were mortality 0.6% (Epi), pericardial effusion 0.6% (Epi), and haemothorax 3.4% (Endo). The median follow-up is 5 (2-10) years: the pacing system failed in 29% of patients, 13% Endo, and 40% Epi (P < 0.0001). Multivariate analysis showed a significantly higher risk of failure for Epi, a lower implant age, greater the number of leads implanted. The risk of malfunction of the leads increases significantly for Epi and the younger age when implanted. The steroid-eluting leads have a lower risk of malfunction (P = 0.05), steroid-eluting Endo leads provide significantly better outcomes than Epi. Cardiac pacing in paediatric patients with CHD shows satisfactory results in the long term. Endocardial systems show significantly better results than Epi systems. A younger age when implanted is a risk factor for complications at follow-up.
Pacemaker implantation post congenital heart disease surgical repair: tertiary center experience
European Journal of Pediatrics, 2020
This was a retrospective study documenting all pacemaker implantations (PMIs) secondary to postoperative atrioventricular block. A total of 26 patients were included between 2011 and 2020. The incidence rate was 1.8%, with a median follow-up time of 4.5 years. At the time of the initial PMI, the median weight was 5 kg, and the median generator longevity was 45 months. Mean cardiopulmonary bypass and aortic clamp times were significantly longer among surgeries complicated with PMI (P≤ 0.05). Trisomy 21 patients were 4 times more likely to need a PMI (95% CI 1.8-9, P < 0.001). The mean Risk Adjustment in Congenital Heart Surgery and Society of Thoracic Surgery scores were higher in patients with PMI. All initial PMIs were epicardial (18 single chamber). Most patients underwent ventricular septal defect closure (isolated or complex), except for 5 patients who underwent left-sided surgery. Pacing-induced dilated cardiomyopathy occurred in 3 patients. All implanted leads were functional except for 2 leads with high thresholds and another biventricular system infection. There was a 31% rate of pacing reintervention. Conclusion: PMI resulted in significant morbidity but without mortality. The highest risk for PMI was left ventricular outflow tract repair, trisomy 21, prolonged cardiopulmonary bypass, and aortic cross times. What is Known: • Incidence rate for postoperative atrioventricular block requiring pacemaker was at 1.8%, similar to previously published reports. • Longer cardiopulmonary bypass and aortic cross-clamp times were associated with higher risk for developing postoperative persistent atrioventricular block. What is New: • Incidence for persistent atrioventricular block requiring pacemaker was highest among left ventricular outflow tract surgery at 8.6%. • Following all intracardiac repair, Down syndrome patients were 4 times more likely to need a pacemaker implantation compared to the non-syndromic group.
EP Europace, 2007
We aimed to assess the evolution of left ventricular (LV) systolic function in children with right ventricular apical (RVA) pacing for isolated congenital heart block (ICHB) and to identify possible predictors of LV function deterioration. Right ventricular apical pacing can be detrimental to LV function in a significant number of adults. Effects in children are still controversial. Methods and results Left ventricular shortening fraction (LV SF) and QRS duration were retrospectively assessed in 45 children with RVA pacing for ICHB: before pacemaker (PM) implantation, immediately after and then regularly during a follow-up of 58.69 + 45.23 months. Patients were categorized as stable or deteriorators according to an arbitrarily chosen cutoff point of !7% decrease in LV SF. Lupus status was unknown. Overall LV SF did not change significantly (41.42% + 8.21 before pacing, 39.77% + 7.03 immediately after PM implant, 37.43% + 9.91 with chronic pacing, P ¼ NS). Deteriorators (n ¼ 13) had significantly higher baseline heart rate (57.5 + 8.7 vs. 46.9 + 10.5 bpm, P , 0.05) and baseline LV SF (46.17 + 8.13 vs. 38.4 + 6.4%; P , 0.05), a significantly higher proportion of them being implanted before 2 years of age: 8 of 13 (61.5%) vs. 5 of 25 (20%) in the stable group (P , 0.05). Deteriorators had a higher incidence of an initial epicardial lead and narrower native QRS. Conclusion Permanent RVA pacing for ICHB does not necessarily affect LV function in children. The risk of deterioration of LV function seems to be higher in children with higher baseline heart rate and better baseline LV SF, especially with pacing at a younger age, a narrower native QRS and RVA epicardial pacing site.
SURGICAL PACEMAKER INSERTION IN CHILDREN-QUEEN ALIA HEART INSTITUTE EXPERIENCE
Aim: to study the indications for insertion of surgical pacemaker in children with its demographic variables Methods: a retrospective study of all medical notes of cases that needed surgical pacemaker insertion in children between January 2015 and January 2017. Age at insertion of pacemaker, sex, indication of pacemaker insertion, morbidity and mortality related to pacemaker insertion and associated congenital heart or systemic diseases were recorded. Results: we found 32 patients in the study period.14 male patients and 18 female patients. Age range was 1 month to 22 years. The most common indication for pacemaker insertion was post-surgical in 18 cases followed by congenital complete heart block in 14 cases. Of the congenital complete heart block form, 6 cases were associated with other structural heart diseases while 8 cases were not and 3 of those were born to SLE mothers. The most post-surgical cause was VSD closure or repair of AVC in 9 cases (26%). No morbidities or mortalities were recorded related to pacemaker insertion. Conclusion: the most common indication for epicardial pacemaker insertion was post surgery for r structural heart disease especially ASD or VSD closure. Congenital heart block is the 2nd most common cause with and without associated intra cardiac defects. Keywords: epicardial, pacemaker, heart block.