Outcome of single-chamber, ventricular pacemakers with transvenous leads implanted in children.
OBJECTIVE
In children with bradyarrhythmias, ventricular demand, rate-responsive pacemakers (VVI/R PM) are often indicated, but no study is entirely dedicated to their outcome.


RESULTS
We evaluated the outcomes of children with VVI/R PM implanted at our centre, with a retrospective analysis. Between 1990 and 2005, 117 children (63 with congenital heart defects), received VVI/R PM with endocardial lead at 5.3 +/- 3.9 years of age for atrioventricular block (n = 105) and sinus node dysfunction. The majority of the leads were unipolar (n = 78), tined (n = 110), and steroid eluting (n = 89). The leads were fixed to subcutaneous tissues by absorbable suture in all patients; in 17 patients, also an atrial loop was created. Follow-up (FU) was 7.8 +/- 4.1 years. There were 22 system failures (19%), due to lead malfunction (n = 20) and system erosion/infection. The log-rank test for equality of survivor functions showed no significant risk factor. However, lead malfunction occurred only in the group without loop, but FU duration was longer in these patients. Complications at implantation were haemothorax (2.5%) and lead dislodgement (5%). Clinically silent occlusion of the subclavian vein was documented at FU by Echo-Doppler in 5%.


CONCLUSIONS
In this particular group of patients, VVI/R pacing has good results, but after long-term FU shows 19% of failures, mainly lead-related.
Silvetti
Massimo Stefano
MS
Servizio di Aritmologia, Dipartimento Medico-Chirurgico di Cardiologia Pediatrica, Bambino Gesù Pediatric Hospital, IRCCS, Piazza S. Onofrio 4, 00165 Roma, Italy. silvetti@opbg.net
Drago
Fabrizio
F
Marcora
Simona
S
Ravà
Lucilla
L
D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004567:Electrodes, Implanted; D004699:Endocardium / Q000473:pathology; D006325:Heart Atria / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010138:Pacemaker, Artificial; D011474:Prosthesis Design; D012189:Retrospective Studies; D016896:Treatment Outcome