Bhattacharya Deepanjan, Namboodiri Narayanan, Nair Krishna Kumar Mohanan, Dharan Baiju S, Sasikumar Deepa, Gopalakrishnan Arun, Krishnamoorthy K M, Menon Sabarinath, Ramanan Sowmya, Baruah Sudip Dutta
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
Ann Pediatr Cardiol. 2024 Mar-Apr;17(2):97-100. doi: 10.4103/apc.apc_37_24. Epub 2024 Jul 20.
Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems.
We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute.
The median age at implantation was 2 days (interquartile range 1-9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2-123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period.
PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction.
新生儿永久性起搏器植入术（PPI）在适应证、设备选择、植入技术和长期预后方面都具有挑战性。复杂的解剖结构、长期高频率起搏的需求以及术后问题较多是主要难题。
我们对在我院出生28天内接受PPI的22例新生儿进行了前瞻性随访。
植入时的中位年龄为2天（四分位间距1 - 9天），9%为早产儿。植入前的平均心率为46.4±7.2次/分钟。8例（36.4%）新生儿母亲狼疮抗体呈阳性，11例（50.0%）患有先天性心脏病。19例新生儿接受了单腔（VVI）起搏器植入，3例接受了双腔（DDD）起搏器植入。中位随访46个月（范围2 - 123个月），平均心室起搏百分比为87.5±24.9%，起搏阈值稳定。7例儿童因电池耗尽在中位年龄47个月时进行了脉冲发生器更换。5例儿童在中位年龄23.6个月时出现起搏诱导的心室功能障碍，2例升级为心脏再同步治疗。总体死亡率为13.6%，均因植入后组织灌注不足和乳酸酸中毒所致。
新生儿PPI预后良好，电极导线存活率高。总体死亡率为13.6%，主要发生在植入后，与心肌功能障碍有关。
