title: Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation.
abstract: OBJECTIVE
  To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with permanent pacemaker implantation.
  
  
  METHODS
  The records of pediatric patients who had apparent breath-holding spells and associated bradycardia and were treated with permanent pacemaker implantation were reviewed.
  
  
  RESULTS
  Ten pediatric patients with apparent breath-holding spells associated with bradycardia were treated with a permanent ventricular demand pacemaker at the Mayo Clinic between 1985 and 1995. Patients had onset of symptoms between ages 6 days and 12 months and presented for evaluation between ages 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms documented asystolic pauses of 1.7 to 24 seconds (mean: 11.9 seconds). Permanent ventricular demand pacemakers were implanted at 10 months to 5 years of age (median: 14.5 months): 9 endocardial and 1 epicardial. Three patients required pacemaker revision. At follow-up of 38 to 170 months (median: 65.5), 5 patients had complete resolution of spells, 2 had only mild color change without loss of consciousness or seizure activity, and 3 continued to have minor brief spells.
  
  
  CONCLUSIONS
  Permanent pacemaker therapy for children with pallid breath-holding spells associated with severe bradycardia is safe, efficacious, and warranted.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Kelly
authors.forename: C J
authors.initials: CJ
authors.lastname: Porter
authors.forename: M D
authors.initials: MD
authors.lastname: McGoon
authors.forename: R E
authors.initials: RE
authors.lastname: Espinosa
authors.forename: M J
authors.initials: MJ
authors.lastname: Osborn
authors.forename: D L
authors.initials: DL
authors.lastname: Hayes
mesh_terms: D001049:Apnea / Q000150:complications*; D001919:Bradycardia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000150:complications; D004562:Electrocardiography; D005062:European Union; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D019736:Prostheses and Implants; D012640:Seizures / Q000150:complications; D014474:Unconsciousness / Q000150:complications