Fazio Giovanni, Silvetti Massimo Stefano, Drago Fabrizio
Struttura Semplice di Aritmologia, Dipartimento Medico Chirurgico di Cardiologia Pediatrica, Ospedale Pediatrico Bambino Gesü, Roma.
G Ital Cardiol (Rome). 2006 Sep;7(9):612-7.
Ventricular pacing, typically initiated from a right ventricular apical electrode, inherently causes abnormal biventricular activation, decreases left ventricular function, and may cause histopathological changes. Data regarding cardiac resynchronization therapy in pediatric patients are limited. Some authors evaluated the potential of improving paced left ventricular function by a septal electrode implant site. For this reason the role of pacing is not clear in children. In isolated congenital atrioventricular block, cardiac pacing represents a satisfactory treatment. However, recent evidence has demonstrated that a subset of patients with isolated congenital complete atrioventricular block develops dilated cardiomyopathy. Patients with congenital heart diseases after surgery represent a unique and expanding population. Some will require pacemaker or implantable defibrillator therapy. They pose technical and management challenges not encountered in other groups receiving pacing, and the complication and reintervention rates specific to this population are not well defined. Moreover, the small patient size, structural cardiac abnormalities, and growth may complicate pediatric pacemaker management. Better knowledge of risk factors for lead failure in these patients may help improve future outcomes. In this review we analyzed many of these problems.
心室起搏通常由右心室心尖电极启动，本质上会导致双心室激活异常，降低左心室功能，并可能引起组织病理学变化。关于儿科患者心脏再同步治疗的数据有限。一些作者评估了通过间隔电极植入部位改善起搏左心室功能的潜力。因此，起搏在儿童中的作用尚不清楚。在孤立性先天性房室传导阻滞中，心脏起搏是一种令人满意的治疗方法。然而，最近的证据表明，一部分孤立性先天性完全性房室传导阻滞患者会发展为扩张型心肌病。先天性心脏病术后患者是一个独特且不断扩大的群体。一些患者将需要起搏器或植入式除颤器治疗。他们带来了其他接受起搏的群体未遇到的技术和管理挑战，并且该群体特有的并发症和再次干预率尚未明确界定。此外，患者体型小、心脏结构异常和生长可能会使儿科起搏器管理复杂化。更好地了解这些患者导线故障的危险因素可能有助于改善未来的治疗结果。在本综述中，我们分析了其中许多问题。
