Kelly A M, Porter C J, McGoon M D, Espinosa R E, Osborn M J, Hayes D L
Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Pediatrics. 2001 Sep;108(3):698-702. doi: 10.1542/peds.108.3.698.
To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with permanent pacemaker implantation.
The records of pediatric patients who had apparent breath-holding spells and associated bradycardia and were treated with permanent pacemaker implantation were reviewed.
Ten pediatric patients with apparent breath-holding spells associated with bradycardia were treated with a permanent ventricular demand pacemaker at the Mayo Clinic between 1985 and 1995. Patients had onset of symptoms between ages 6 days and 12 months and presented for evaluation between ages 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms documented asystolic pauses of 1.7 to 24 seconds (mean: 11.9 seconds). Permanent ventricular demand pacemakers were implanted at 10 months to 5 years of age (median: 14.5 months): 9 endocardial and 1 epicardial. Three patients required pacemaker revision. At follow-up of 38 to 170 months (median: 65.5), 5 patients had complete resolution of spells, 2 had only mild color change without loss of consciousness or seizure activity, and 3 continued to have minor brief spells.
Permanent pacemaker therapy for children with pallid breath-holding spells associated with severe bradycardia is safe, efficacious, and warranted.
确定患有与心动过缓相关的苍白屏气发作的儿童能否通过植入永久性起搏器得到安全且成功的治疗。
回顾了患有明显屏气发作及相关心动过缓并接受永久性起搏器植入治疗的儿科患者的记录。
1985年至1995年间，梅奥诊所对10例患有明显的与心动过缓相关的屏气发作的儿科患者植入了永久性心室按需起搏器。患者症状出现的年龄在6天至12个月之间，前来评估的年龄在12个月至5岁之间。发作持续时间为15秒至10分钟。预防发作的药物治疗无效。心电图记录到无收缩期停顿为1.7至24秒（平均：11.9秒）。永久性心室按需起搏器在10个月至5岁时植入（中位数：14.5个月）：9例为心内膜起搏，1例为心外膜起搏。3例患者需要对起搏器进行翻修。在38至170个月的随访期（中位数：65.5个月），5例患者发作完全缓解，2例仅有轻微的面色改变，未出现意识丧失或癫痫活动，3例仍有轻微短暂发作。
对于患有与严重心动过缓相关的苍白屏气发作的儿童，永久性起搏器治疗是安全、有效的，且是必要的。
