Klug Didier, Vaksmann Guy, Jarwé Moustapha, Wallet Frédéric, Francart Charles, Kacet Salem, Rey Christian
Electrophysiology and Cardiac Pacing Pediatric Cardiology and Congenital Heart Disease Bacteriology, University of Lille, France.
Pacing Clin Electrophysiol. 2003 Jul;26(7 Pt 1):1489-93. doi: 10.1046/j.1460-9592.2003.t01-1-00215.x.
Transvenous pacing has become widespread in the pediatric population, but related pacemaker lead infection in young patients has rarely been reported. To determine prevalence and optimal management of pacemaker lead infection in children and young adults, the authors reviewed their pacing database including 4476 patients who previously had pacemaker implantations from 1975 to 2001. A pacemaker was implanted in 304 patients under the age of 40. Of these patients 217 of them had congenital heart disease: 108 with structural defect, 109 without (mainly complete AV blocks). Among patients with congenital heart disease, 12 developed a pacemaker lead infection (5.5%, 6 patients with structural defect, 6 without). This incidence was significantly higher than in patients < 40 years at first implantation without congenital heart disease (2.3%) and in > 40-year-old patients(1.2%, P < 0.001). However, the number of reinterventions at the pulse generator site was higher in patients having had their first implantation before the age of 40. In patients with structural cardiac defect: two died after surgical lead extraction and one died before the scheduled lead extraction. The three remaining patients had successful surgical (n = 1) or percutaneous (n = 2) lead extractions. In patients without structural cardiac defect successful percutaneous extraction (5/6) or surgical extraction (1/6 with vegetation > 25 mm) was performed. One patient with percutaneous extraction developed chronic cor pulmonale during follow-up. One infection recurred in one patient with structural cardiac defect although complete removal of the pacing material had been performed. The prevalence of pacemaker lead infection is higher in younger patients, perhaps in part due to a higher number of procedures at the pacemaker site than in the general population of patients with a pacemaker. Patients with structural cardiac defect who underwent surgical lead removal were at high risk for death. Patients with percutaneous lead extraction may develop cor pulmonale.
经静脉起搏在儿科人群中已广泛应用，但年轻患者中相关起搏器导线感染的报道却很少。为了确定儿童和青年成人起搏器导线感染的患病率及最佳处理方法，作者回顾了他们的起搏数据库，其中包括1975年至2001年间曾植入起搏器的4476例患者。304例40岁以下患者植入了起搏器。这些患者中，217例患有先天性心脏病：108例有结构缺陷，109例无结构缺陷（主要是完全性房室传导阻滞）。在先天性心脏病患者中，12例发生了起搏器导线感染（5.5%，6例有结构缺陷，6例无结构缺陷）。这一发生率显著高于首次植入时年龄小于40岁且无先天性心脏病的患者（2.3%）以及40岁以上患者（1.2%，P<0.001）。然而，首次植入年龄在40岁之前的患者在脉冲发生器部位的再次干预次数较多。在有心脏结构缺陷的患者中：2例在手术拔除导线后死亡，1例在计划拔除导线前死亡。其余3例患者成功进行了手术（n = 1）或经皮（n = 2）导线拔除。在无心脏结构缺陷的患者中，成功进行了经皮拔除（5/6）或手术拔除（1/6有>25mm赘生物）。1例经皮拔除患者在随访期间发生了慢性肺心病。1例有心脏结构缺陷的患者尽管已完全移除起搏材料，但仍有1例感染复发。年轻患者中起搏器导线感染的患病率较高，这可能部分归因于起搏器部位的操作次数多于一般起搏器患者人群。接受手术拔除导线的有心脏结构缺陷的患者死亡风险较高。经皮拔除导线的患者可能会发生肺心病。
