Abstract
Pediatric pacemaker (PM) implants comprise less than 1 % of all PM implants. This study aimed to investigate permanent cardiac pacing among the pediatric population, identifying different indications and complications of pediatric cardiac pacing, especially focusing on the effect of the pacing sites, the PM lead type, and the indications for pacing. The current work is a cross-sectional study of 103 procedures for permanent PM insertion in pediatric patients between January 2001 and December 2010. The patients were followed up 1, 3, and 6 months after implantation, then every 6 months or as needed. Evaluation included routine clinical examination, electrocardiography, chest X-ray, echocardiography, and a full analysis of the pacing system measurements. The ages of the patients ranged from 0.09 to 12 years (median, 2.3 years). The most common indication for pacing was postoperative complete heart bock, noted in 54 patients (52.4 %). Transvenous endocardial PM insertion was performed in 92 procedures (89.3 %), whereas transthoracic epicardial insertion was performed in 11 procedures (10.7 %). The most common site of pacing was the right ventricular apex (n = 64, 62 %), followed by the right ventricular outflow tract (n = 25, 24.3 %). Transthoracic epicardial PM insertion was associated with a significantly higher percentage and greater severity of complications. In this study, 65 % of the patients with left ventricle (LV) dilation before pacing showed a significant improvement in LV dimensions and function after pacing. This was noted only in those with endocardially inserted PM leads in both the congenital and the postoperative groups regardless of the pacing site. Endocardial PM insertion in children is a safe procedure with fewer complications and a lower ventricular threshold than the epicardial route. Permanent single-chamber right ventricle pacing is safe and can lead to significant improvement in LV function and dimensions. However, long-term follow-up assessment is needed for further evaluation.
Similar content being viewed by others
References
Antretter H, Colvin J, Schweigmann U, Hangler H, Höfer D, Dunst K, Margreiter J, Laufer G (2003) Special problems of pacing in children. Indian Pacing Electrophysiol J 3:23
Batra AS, Wells WJ, Hinoki KW, Stanton RA, Silka MJ (2003) Late recovery of atrioventricular conduction after pacemaker implantation for complete heart block associated with surgery for congenital heart disease. J Thorac Cardiovasc Surg 125:1291–1293
Brockmeier K, Ulmer HE, Hessling G (2002) Termination of atrial reentrant tachycardias by using transesophageal atrial pacing. J Electrocardiol 35:159–163
Çeliker A, Başpınar O, Karagöz T (2007) Transvenous cardiac pacing in children: problems and complications during follow-up. Original investigation. Anadolu Kardiyol Derg 7:292–297
Doniger SJ, Sharieff GQ (2006) Pediatric dysrhythmias. Pediatr Clin North Am 53(1):85–105
Ector B, Willems R, Heidbüchel H, Gewillig M, Mertens L, Meyns B, Daenen W, Ector H (2006) Epicardial pacing: a single-centre study on 321 leads in 138 patients. Acta Cardiol 61:343–351
Fortescue EB, Berul CI, Cecchin F, Walsh EP, Triedman JK, Alexander ME (2004) Patient, procedural, and hardware factors associated with pacemaker lead failures in pediatrics and congenital heart disease. Heart Rhythm 1:150–159
Gebauer RA, Tomek V, Salameh A, Marek J, Chaloupecký V, Gebauer R, Matějka T, Vojtovič P, Janoušek J (2009) Predictors of left ventricular remodelling and failure in right ventricular pacing in the young. Eur Heart J 30:1097–1104
Gross GJ, Chiu CC, Hamilton RM, Kirsh JA, Stephenson EA (2006) Natural history of postoperative heart block in congenital heart disease: implications for pacing intervention. Heart Rhythm 3:601–604
Kammeraad JA, Rosenthal E, Bostock J, Rogers J, Sreeram N (2004) Endocardial pacemaker implantation in infants weighing < or = 10 kilograms. Pacing Clin Electrophysiol 27:1466–1474
Karpawich PP (2004) Chronic right ventricular pacing and cardiac performance: the pediatric perspective. Pacing Clin Electrophysiol 27:844–849
Kumor M, Baranowski R, Koźluk E, Walczak F (2010) Is the diagnostic function of pacemakers a reliable source of information about ventricular arrhythmias? Cardiol J 17:495–502
McLeod KA (2010) Cardiac pacing in infants and children. Heart 96:1502–1508
Nolasco RR, Avalos OM, Diez RG, Carrillo JC, Machuca RJ, De Haro S, Villacorta CH (2009) Transvenous pacing in children weighing less than 10 kilograms. Pacing Clin Electrophysiol 32:177–181
Odim J, Suckow B, Saedi B, Laks H, Shannon K (2008) Equivalent performance of epicardial versus endocardial permanent pacing in children: a single-institution and manufacturer experience. Ann Thorac Surg 85:1412–1416
Post MC, Budts W, Van de Bruaene A, Willems R, Meyns B, Rega F, Gewillig M (2011) Failure of epicardial pacing leads in congenital heart disease: not uncommon and difficult to predict. Neth Heart J 19(7–8):331–335
Sachweh JS, Vazquez-Jimenez JF, Schöndube FA, Daebritz SH, Dörge H, Mühler EG, Messmer BJ (2000) Twenty years experience with pediatric pacing: epicardial and transvenous stimulation. Eur J Cardiothorac Surg 17:455–461
Shalganov TN, Paprika D, Vatasescu R, Kardos A, Mihalcz A, Kornyei L, Szatmari A, Szili-Torok T (2007) Midterm echocardiographic follow-up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease. Cardiovasc Ultrasound 5:13
Silvetti MS, Drago F (2006) Upgrading of VVIR pacemakers with nonfunctional endocardial ventricular leads to VDD pacemakers in adolescents. Pacing Clin Electrophysiol 29:691–696
Silvetti MS, De Santis A, Grovale N, Grutter G, Baccarini A, Drago F (2007) Ventricular pacing threshold variations in the young. Pacing Clin Electrophysiol 30:175–181
Soongswang J, Nana A, Laohaprasittiporn D, Durongpisitkul K, Chanthong P, KhaoSa-Ard B, Punlee K, Kangkakate C, Udompunturuk S (2005) Permanent cardiac pacing in pediatrics: experience in Thailand. J Med Assoc Thai 88:106–114
Toogood G (2007) Pacemaker therapies in cardiology. Aust Fam Physician 36:518–524
Udink ten Cate F, Breur J, Boramanand N, Crosson J, Friedman A, Brenner J, Meijboom E, Sreeram N (2002) Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group. Heart 88:392–396
Welisch E, Cherlet E, Crespo-Martinez E, Hansky B (2010) From pacing and clinical electrophysiology: a single-institution experience with pacemaker implantation in a pediatric population over 25 years. Pacing Clin Electrophysiol 33:1112–1118
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lotfy, W., Hegazy, R., AbdElAziz, O. et al. Permanent Cardiac Pacing in Pediatric Patients. Pediatr Cardiol 34, 273–280 (2013). https://doi.org/10.1007/s00246-012-0433-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-012-0433-2