Soongswang Jarupim, Nana Apichart, Laohaprasittiporn Duangmanee, Durongpisitkul Kritvikrom, Chanthong Prakul, KhaoSa-Ard Burin, Punlee Kesaree, Kangkakate Charuwan, Udompunturuk Suthipol
Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Mahidol University, Bangkoknoi, Bangkok, Thailand.
J Med Assoc Thai. 2005 Nov;88 Suppl 8:S106-14.
Permanent cardiac pacing in pediatrics is uncommon. There has been limited data in Thailand. A retrospective study of cardiac data and pacing parameters during follow-up periods in patients who underwent permanent pacemaker implantation at the Department of Pediatrics, Siriraj Hospital, from January 1997 to December 2004 was conducted. There were 31 patients in total who have been followed-up for the median period of 34.4 (1.07-91.13) months. All patients had atrio-ventricular block prior to implantation. The etiology were; post cardiac surgery 38.7%, maternal autoimmune diseases 19.4%, post radiofrequency ablation 3.2%, and unknown 38.7%. Twenty three cases (74.2%) were implanted by epicardial approach, and 18 (25.8% were implanted by endocardial approach. Modes of permanent pacemaker were WIR 45.2%, VVI 35.5%, and DDD 19.4%. Age and body sized of the patients using epicardial approach were significantly lower than endocardial approach. Minor complications occurred in 3 cases (9.6%) i.e. 2 with surgical wound infection, 1 with post pericardiotomy syndrome. Minimum energy threshold, sensitivity, and impedance at implantation and during follow up periods were not different statistically. There was significantly less in minimum energy threshold of endocardial lead than epicardial lead. Epicardial lead failure was found in 3 cases (11.5%) at the median time of 8.9 (7.9-62) months post implantation, but was not significant different from endocardial leads. Survival of epicardial leads were 82% at 8 years.
Permanent pacemaker implantation in pediatrics was rare (4.4 cases/year). It was feasible in almost all body size and a rather safe procedure. There was no significant change in pacing parameters at the medium-term follow-up period for both epicardial and endocardial leads. Minimum energy threshold of epicardial lead was significantly higher than endocardial lead.
小儿永久性心脏起搏并不常见。泰国的相关数据有限。对1997年1月至2004年12月在诗里拉吉医院儿科接受永久性起搏器植入的患者随访期间的心脏数据和起搏参数进行了回顾性研究。共有31例患者接受了中位时长为34.4（1.07 - 91.13）个月的随访。所有患者在植入前均患有房室传导阻滞。病因如下：心脏手术后38.7%，母体自身免疫性疾病19.4%，射频消融术后3.2%，病因不明38.7%。23例（74.2%）采用心外膜途径植入，18例（25.8%）采用心内膜途径植入。永久性起搏器模式为WIR占45.2%，VVI占35.5%，DDD占19.4%。采用心外膜途径的患者年龄和体型明显低于心内膜途径。3例（9.6%）出现轻微并发症，即2例手术伤口感染，1例心包切开术后综合征。植入时及随访期间的最小能量阈值、灵敏度和阻抗在统计学上无差异。心内膜导联的最小能量阈值明显低于心外膜导联。在心外膜导联植入后中位时间8.9（7.9 - 62）个月时发现3例（11.5%）心外膜导联故障，但与心内膜导联无显著差异。心外膜导联8年生存率为82%。
小儿永久性起搏器植入罕见（每年4.4例）。几乎适用于所有体型，是一种相当安全的手术。心外膜和心内膜导联在中期随访期间起搏参数无显著变化。心外膜导联的最小能量阈值明显高于心内膜导联。
