title: Postpericardiotomy syndrome after permanent pacemaker implantation in children and young adults.
abstract: 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.
authors.affiliation: 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
authors.forename: Ilana
authors.initials: I
authors.lastname: Zeltser
authors.forename: Larry A
authors.initials: LA
authors.lastname: Rhodes
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Vetter
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Mitchell I
authors.initials: MI
authors.lastname: Cohen
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal