Kelle Angela M, Backer Carl L, Tsao Sabrina, Stewart Robert D, Franklin Wayne H, Deal Barbara J, Mavroudis Constantine
Division of Cardiovascular and Thoracic Surgery, Children's Memorial Hospital, Chicago, Ill 60614, USA.
J Thorac Cardiovasc Surg. 2007 Nov;134(5):1188-92. doi: 10.1016/j.jtcvs.2007.04.049.
This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block.
From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 +/- 5.6 days and 2.8 +/- 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets.
Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 +/- 2.6 mV and atrial voltage threshold was 0.8 +/- 0.3 V. Mean R-wave sensing was 13.0 +/- 5.7 mV and ventricular voltage threshold 0.9 +/- 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 +/- 7.1 years with 1 patient lost to follow-up.
Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.
本综述评估使用双腔起搏器治疗先天性心脏传导阻滞新生儿的治疗策略的结果。
1989年至2006年，10例先天性心脏传导阻滞新生儿接受了双腔心外膜起搏器植入术。平均年龄和体重分别为4.4±5.6天和2.8±0.6千克。4例患者患有异构综合征，需要同时进行心脏手术。1例患者有胎儿水肿、心肌炎和心肌病。5例患者心脏结构正常。均采用胸骨切开术（2例部分切开，8例完全切开）和单极导线（2例非类固醇洗脱，18例类固醇洗脱）。发生器置于双侧腹直肌鞘肌下袋中。
所有患者均成功建立房室同步。平均P波感知为4.7±2.6毫伏，心房电压阈值为0.8±0.3伏。平均R波感知为13.0±5.7毫伏，心室电压阈值为0.9±0.5伏。无伤口并发症或急性导线故障。术后中位住院时间为14天。4例异构综合征患者中有3例分别在术后3天、14天和15个月死亡。心肌病患者在急性心肌炎6个月时突然死亡。心脏结构正常的患者无死亡（P<0.05）。幸存者的平均随访间隔为6.1±7.1年，1例失访。
先天性心脏传导阻滞新生儿植入双腔心外膜起搏器在技术上是可行的，对于心脏结构正常的患者可产生良好的结果。6年时系统寿命良好。尽管采用双腔起搏，先天性心脏传导阻滞和异构综合征患者的预后仍较差。
