title: Pacemaker system failure and other events in children with surgically induced heart block.
abstract: 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 + 15% at 96 months. Only first reoperation was found to be an incremental risk factor for subsequent reoperation (p = 0.03). Surgical heart block has been neutralized as a risk factor for hospital death after repair of congenital cardiac defects. The risk of the development of surgical heart block now approaches zero, as indicated by a decreased incidence (1 of 401 = 0.25%) in our institution from 1985 to 1987, as compared to the era 1975 to 1984 (p = 0.001).
authors: Department of Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015.
authors: L B
authors: LB
authors: McGrath
authors: L
authors: L
authors: Gonzalez-Lavin
authors: D P
authors: DP
authors: Morse
authors: J M
authors: JM
authors: Levett
mesh_terms: D000206:Actuarial Analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012086:Reoperation; D013997:Time Factors