Permanent cardiac pacing in children: morbidity and efficacy of follow-up.
The data from 50 permanently paced children [mean standard deviation follow-up 5.3 +/- 3.7 years] were reviewed, with special attention being paid to the cause of complications and the efficacy of follow-up. The 5-year survival (SD) of the patients was 78 +/- 6%; mortality was mainly due to the underlying cardiac disease. The 5-year survival (SD) of the pacing systems was 48 +/- 8%. Surgical interventions were necessary every 4.9 patient years. Of these interventions, 58% were caused by lead-related problems. Epicardial leads showed significantly more exit blocks and high thresholds than endocardial leads. Endocardial leads, therefore, should be used at a younger age than is now the current practice, from 5 years of age onwards, for example. If epicardial leads are used, the pacemaker must have a high output facility. Since exit block occurred only within the first 3 months after implantation, we suggest frequent transtelephonic monitoring during the first 3 months. Holter monitoring appeared to be the most effective and sensitive method of detecting malsensing and should be performed regularly.
Kerstjens-Frederikse
M W
MW
Division of Paediatric Cardiology, University of Groningen, The Netherlands.
Bink-Boelkens
M T
MT
de Jongste
M J
MJ
Homan van der Heide
J N
JN
D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006327:Heart Block / Q000151:congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D009426:Netherlands / Q000453:epidemiology; D010138:Pacemaker, Artificial / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate