Silvetti Massimo Stefano, Drago Fabrizio, De Santis Antonella, Grutter Giorgia, Ravà Lucilla, Monti Lidia, Fruhwirth Rodolfo
Department of Pediatric Cardiology, Ospedale Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Roma, Italy.
Europace. 2007 Jun;9(6):426-31. doi: 10.1093/europace/eum043. Epub 2007 Apr 24.
Endocardial (ENDO) or epicardial (EPI) pacing systems are implanted in infants but it remains unclear which system should be preferred.
We evaluated the results of children <or=1 year who underwent pacemaker (PM) implantation at our centre with a retrospective analysis. Between 1992 and 2004, 56 patients, 37 of whom had other congenital heart defects (CHDs), received a PM at 4.4 +/- 3.8 months of age for atrioventricular block (n = 52) and sinus node dysfunction. Rate-responsive ventricular demand pacing (VVIR) PMs were implanted in 25 patients (19 ENDO), dual-chamber demand pacing (DDD) in 29, and rate-responsive atrial demand pacing (AAIR) in 2 (all EPI). Follow-up (FU) was 4.5 +/- 3.5 (range 0.3-13) years: 15 pacing system failures occurred among the 56 patients (26%) after 4.5 +/- 3.2 years, with a significantly reduced success rate for EPI (21-fold increase of the risk of failure) and complex CHD. Also in patients without surgery for CHD, EPI showed a worse outcome. Among the 91 leads implanted, failures occurred more significantly in EPI (18% of atrial, 24% of ventricular leads) than in ENDO (5% of ventricular leads). No venous occlusion was found at FU.
Single-lead, VVIR ENDO pacing had higher efficiency and safety than EPI, and it might be the best choice for PM implantation in infants. However, because of small patient numbers and lack of longer FU, these findings should be treated with caution.
心内膜（ENDO）或心外膜（EPI）起搏系统用于婴儿植入，但哪种系统更优仍不明确。
我们通过回顾性分析评估了在本中心接受起搏器（PM）植入的1岁及以下儿童的结果。1992年至2004年期间，56例患者（其中37例患有其他先天性心脏病（CHD））在4.4±3.8个月大时因房室传导阻滞（n = 52）和窦房结功能障碍接受了PM植入。25例患者（19例ENDO）植入了频率应答式心室按需起搏（VVIR）PM，29例植入了双腔按需起搏（DDD），2例（均为EPI）植入了频率应答式心房按需起搏（AAIR）。随访（FU）时间为4.5±3.5（范围0.3 - 13）年：56例患者中有15例（26%）在4.5±3.2年后发生起搏系统故障，EPI的成功率显著降低（失败风险增加21倍）且合并复杂CHD。在未接受CHD手术的患者中，EPI的结果也较差。在植入的91根导线中，EPI发生故障的比例（心房导线的18%，心室导线的24%）比ENDO（心室导线的5%）更显著。随访时未发现静脉闭塞。
单导联、VVIR ENDO起搏比EPI具有更高的效率和安全性，可能是婴儿PM植入的最佳选择。然而，由于患者数量少且缺乏更长时间的随访，这些发现应谨慎对待。
