Jimenez M, Fournier A, Héry E, Montigny M, Kratz C, Chartrand C, Stanley P, Davignon A
Services de cardiologie et de chirurgie cardiaque, hôpital Sainte-Justine, Montréal, Québec.
Arch Mal Coeur Vaiss. 1988 May;81(5):665-70.
Between 1971 and 1986, 85 pacemakers were implanted at the St Justine Hospital, Montreal, in 57 young patients (25 girls, 32 boys) then aged from one day to 23 years (mean 10.3 years). The patients were followed up for periods ranging from 15 days to 13.5 years (mean 4.5 years); 119 epicardial electrodes were positioned by thoracotomy in 52 patients and by sternotomy in 5 patients; the 85 pacemaker cases were placed in the left retroperitoneal cavity. The pacemakers were programmed in modes VVI (28), AAI (1) and DDD (28). The indications for pacemaker implantation were: complete atrioventricular block in 39 cases (postoperative 16, congenital 22, acquired 1), sinus node disease in 17 cases (postoperative 13, cardiomyopathy 3, normal heart 1) and Romano-Ward syndrome in 1 case. Operated heart diseases which required pacemaker implantation were: D-transposition of the great arteries in 17 cases (complete atrioventricular block 7, sinus node disease 10), tricuspid valve atresia in 3 cases (sinus node disease 3) and tetralogy of Fallot in 3 cases (complete atrioventricular block 3). Twenty-four patients underwent a total of 33 reoperations: 21 changes of battery, 12 changes of electrodes (6 for fibrosis, 6 for breakage). Only one patient developed infection of the pacemaker case. Altogether, the incidence of complications (infection and/or breakage) was low in this series, regardless of the pacing mode. Pacing in children is now an acceptable treatment with low risk provided the indications are well selected.
1971年至1986年间，蒙特利尔圣贾斯汀医院为57名年轻患者（25名女孩，32名男孩）植入了85台起搏器，这些患者年龄在1天至23岁之间（平均10.3岁）。对患者进行了15天至13.5年（平均4.5年）的随访；52例患者通过开胸术、5例患者通过胸骨切开术放置了119个心外膜电极；85例起搏器置于左腹膜后腔。起搏器的程控模式为VVI（28例）、AAI（1例）和DDD（28例）。起搏器植入的适应证为：完全性房室传导阻滞39例（术后16例，先天性22例，后天性1例），窦房结疾病17例（术后13例，心肌病3例，心脏正常1例），Romano-Ward综合征1例。需要植入起搏器的手术心脏病包括：大动脉转位17例（完全性房室传导阻滞7例，窦房结疾病10例），三尖瓣闭锁3例（窦房结疾病3例），法洛四联症3例（完全性房室传导阻滞3例）。24例患者共接受了33次再次手术：21次更换电池，12次更换电极（6次因纤维化，6次因断裂）。仅1例患者发生起搏器囊袋感染。总体而言，无论起搏模式如何，该系列并发症（感染和/或断裂）的发生率都很低。只要适应证选择得当，儿童起搏目前是一种风险较低且可接受的治疗方法。
