Cardiac Pacing in Children: A French Multicenter Study of 241 Patients
This study includes 241 children implanted from 1965 to March 1982 in 9 French Hospital centers.
Ages at first implantation are as follows: ≤ 5 years = 32.8%, from 6 to 10 years = 33.6%, over 11 up to 16.5 years = 33.6%.
Congenital heart block was present in 98 (40.7%) cases and post-surgical block in 136 (56.4%) of which 34 interventricular septal defects, tetralogy: 33, AV canal: 18. Symptoms leading to implantation were mainly: syncopes (67), bradycardia (92), heart failure (33). The main ECG indication was 3rd degree A V block, 66.8% of cases.
The abdominal profound location is chosen in 71.8% of cases. Energy sources of devices in service are, as of August 1982, lithium (74%) and isotope powered (26%) batteries.
Myocardial leads are placed in 93.4% of cases, among them 82.2% are Medtronic leads.
Early post-operative failures are mainly: infection (10), endocardial lead dislodgement (3), high thresholds (2). Late complications: lead fracture (19), and high thresholds (50).
Two-hundred and seven children are still alive and healthy. They required 341 PG’s of which 90% were VVI mode devices. As of August 1982, 56.5% are programmable or multiprogrammable pacemakers.
In spite of remaining technical problems, myocardial approach was mainly and satisfactorily used in young children and infants. However endocardial approach seems to offer an alternative in children aged 5 years and above. It’s likely that, in a near future, “physiological” devices will be more widely used in children in order to assure better haemodynamic conditions.
KeywordsCardiac Pace Sick Sinus Syndrome Congenital Heart Block Atrioventricular Septal Defect Lead Fracture
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