Zhao P J, Chen Y W, Li F, Li Y, Yang J P, Wu J J
Department of Pediatric Cardiology, Shanghai Xinhua Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai 200092, China.
Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, School of Medicine, Shanghai 200127, China.
Zhonghua Er Ke Za Zhi. 2017 Jul 2;55(7):514-518. doi: 10.3760/cma.j.issn.0578-1310.2017.07.009.
To analyze characteristics of permanent pacemaker implantation in children as well as treatment and prognosis of complications. Clinical data of children who underwent endocardial or epicardial permanent pacemaker implantation between April 2000 and June 2016 in Shanghai Xinhua Hospital and Shanghai Children's Medical Center were analyzed retrospectively. These patients were discharged 5 days after implantation. Electrocardiogram, chest X ray, echocardiography and pacemaker programming were performed during follow-up. Treatment regimes, complication management and prognosis were analyzed retrospectively. Data of a total of 193 cases were collected. One hundred and six patients were male and 87 patients were female.The average age was (5.09±4.05) years(0.4-16 years)and the average weight was (20.47±11.62) kg.133(68.9%); patients were implanted with endocardial pacemakers and 60(31.1%)patients were implanted with epicardial pacemakers; 135(69.9%)patients were single-chamber paced with 87 from RVA and 48 from RVOT. fifty-eight(30.1%)patients were dual chamber paced. These included 122(63.2%)postoperative third degree AV block(Ⅲ-AVB), 38 (19.7%)congenital complete AV block (CCAVB), 3(1.6%)post ventricular septal defect (VSD) interventional therapy AV block, 23 (11.9%)sick sinus syndrome (SSS) and 7(3.6%)Ⅲ-AVB after fulminant myocarditis. One hundred and thirty-seven(71%)patients were followed up for an average duration of 5.32 years(0.3-10 years). Pacemaker exchange were performed in 46 patients due to battery exhaustion.The average life of battery was 5.4 years (1-9 years). Sixteen patients underwent lead exchange due to dislocation or separation.One patient underwent lead extraction due to recovery of AV conduction 21 days after surgery for complete transposition of great arteries (D-TGA/VSD). Skin abrasion, infection or dehiscence occured in 6 patients. Heart failure occurred in 2 patients at 6 and 8 years after implantation whose heart functions improved after switching from VVI to DDD or adding ACEI . One patient died suddenly due to ineffective pacing caused by lead fracture. Another patient under DDD pacing was found to have atrial myocardial perforation with normal sensing and pacing so that no intervention was performed. The pacing mode and path through which leads are implanted for permanent pacemaker implantation in children have their peculiar characteristics.Some complications might occur during follow-up with good prognosis if appropriately treated.
分析儿童永久性起搏器植入的特点以及并发症的治疗和预后情况。回顾性分析2000年4月至2016年6月期间在上海新华医院和上海儿童医学中心接受心内膜或心外膜永久性起搏器植入的儿童的临床资料。这些患者在植入后5天出院。随访期间进行心电图、胸部X线、超声心动图和起搏器程控。回顾性分析治疗方案、并发症处理及预后情况。共收集193例患者的数据。男性106例，女性87例。平均年龄为(5.09±4.05)岁(0.4 - 16岁)，平均体重为(20.47±11.62)kg。133例(68.9%)患者植入心内膜起搏器，60例(31.1%)患者植入心外膜起搏器；135例(69.9%)患者为单腔起搏，其中87例起搏部位为右室心尖部(RVA)，48例为右室流出道(RVOT)。58例(30.1%)患者为双腔起搏。其中包括术后三度房室传导阻滞(Ⅲ - AVB)122例(63.2%)、先天性完全性房室传导阻滞(CCAVB)38例(19.7%)、室间隔缺损(VSD)介入治疗后房室传导阻滞3例(1.6%)、病态窦房结综合征(SSS)23例(11.9%)、暴发性心肌炎后Ⅲ - AVB 7例(3.6%)。137例(71%)患者平均随访5.32年(0.3 - 10年)。46例患者因电池耗尽进行了起搏器更换。电池平均寿命为5.4年(1 - 9年)。16例患者因导线脱位或分离进行了导线更换。1例大动脉完全转位(D - TGA/VSD)手术后21天因房室传导恢复进行了导线拔除。6例患者出现皮肤擦伤、感染或裂开。2例患者在植入后6年和8年发生心力衰竭，将起搏模式从VVI转换为DDD或加用ACEI后心功能改善。1例患者因导线断裂导致起搏无效而猝死。另1例DDD起搏患者发现有心房心肌穿孔，但感知和起搏正常，未进行干预。儿童永久性起搏器植入的起搏模式和导线植入途径有其独特特点。随访期间可能会出现一些并发症，如治疗得当，预后良好。
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