Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults.
BACKGROUND
Postpericardiotomy syndrome (PPS) occurs in 10% to 50% of pediatric patients after cardiac surgery. The incidence and outcome of PPS after permanent pacemaker implantation in children is not described.


METHODS
A retrospective analysis was performed of all pediatric patients who underwent isolated placement of a pacemaker between January 1984 and December 2002. Patients who underwent congenital heart surgery at the time of pacemaker implantation were excluded. PPS was diagnosed on the basis of clinical symptoms with echocardiographic confirmation of a pericardial effusion.


RESULTS
Four hundred and forty-three pacemakers (237 epicardial, 206 transvenous) were implanted in 370 patients (median age 10 years, range 2 months to 24 years). Eight (2%) episodes of PPS (6 epicardial, 2 transvenous) occurred in 7 patients. The median time from implantation to PPS was 12.5 days (range 8 to 22 days). Six (75%) episodes followed primary pacemaker implantation, two occurred after subsequent lead revision. Three patients were initially treated with medical therapy (1 nonsteroidal agents, 2 steroids), and 1 required subsequent pericardiocentesis. Five patients underwent initial pericardiocentesis followed by medication. One patient had echocardiographic recurrence of a pericardial effusion 3 weeks after a nonsteroidal taper, with resolution after nonsteroidal agents were reinitiated. One patient required a pericardial window for a persistent effusion. No pacemaker was explanted.


CONCLUSIONS
PPS occurred in 2% of children undergoing isolated pacemaker implantation of both epicardial and transvenous systems. PPS is usually managed successfully with medical therapy. Patients with medical treatment failure were successfully treated with pericardiocentesis or the surgical creation of a pericardial window.
Zeltser
Ilana
I
Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. zeltser@email.chop.edu
Rhodes
Larry A
LA
Tanel
Ronn E
RE
Vetter
Victoria L
VL
Gaynor
J William
JW
Spray
Thomas L
TL
Cohen
Mitchell I
MI
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010138:Pacemaker, Artificial; D010490:Pericardial Effusion / Q000209:etiology; D010491:Pericardial Window Techniques; D010492:Pericardiectomy / Q000009:adverse effects; D020519:Pericardiocentesis; D011185:Postpericardiotomy Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D012189:Retrospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal