A clinical analysis of cardiac pacemaker implantation in 68 children

Abstract:

Objective：To investigate the clinical characteristics of children with cardiac pacemaker implantation. Methods：The clini－cal data of patients with a mean age of （66.96±58.14） months（range，2 hours to 227 months），who underwent cardiac pacemaker implantation in our hospital from September 2011 to October 2017，were retrospective analyzed，including etiology，clinical manifesta－tions，auxiliary examination，pacing methods，cardiac size after implantation，and changes in cardiac function. Results：A total of 68 children were collected，including 61 with temporary pacemaker implantation and 7 with permanent pacemaker implantation in early stage. In the temporary pacemaker group，25 children were treated with epicardial pacemaker implantation during cardiac surgery for congenital heart disease，and 36 children were treated with endocardial pacemaker implantation，including 25 cases of fulminant my－ocarditis，5 cases of Ⅲ-degree atrioventricular block after surgery for congenital heart disease，3 cases of arrhythmia（1 of Ⅲ-degree atrioventricular block after catheter ablation，1 of atrial tachycardia，and 1 of ventricular tachycardia），3 cases of cardiomyopathy with Ⅲ-degree atrioventricular block and supraventricular tachycardia. All the 61 children were given drug therapy simultaneously with temporary pacemaker implantation，46 of whom recovered sinus rhythm within 4 weeks，including 20（20/25，80%） treated with epicardial pacing and 26 treated with endocardial pacing[20（20/25，80%） of fulminant myocarditis，2（2/5，40%） of congenital heart disease，3（3/3，100%） of arrhythmia，and 1（1/3，33.3%） of cardiomyopathy]. Eight children were eventually implanted with permanent pacemaker，six died，and 1 abandoned treatment. The etiologies of 7 children with permanent pacemaker implan－tation in early stage included QT prolongation syndrome in 1 case，congenital sick sinus syndrome in 1 case，fulminant my－ocarditis in 1 case（temporary pacemaker implanted in the other hospital），and Ⅲ-degree atrioventricular block with attack of Adams-Strokes syndrome（unknown etiology） in 4 cases. There were 3 children with electrode displacement during temporary pacing，and 1 with skin pouch infection after permanent pacemaker im－plantation. The temporary pacemaker group showed a significant change in left ventricular end-systolic diameter and left ventricular end-diastolic diameter after implantation，and the permanent pacemaker group showed a significant change in left ventricular end-di－astolic diameter after implantation（P<0.05）. Conclusion：Temporary cardiac pacing can ensure the blood supply of important organs，gain time for drug treatment，and ensure the recovery of cardiac function. Permanent cardiac pacemaker should be implanted if sinus rhythm is not restored within 4 weeks after temporary pacemaker implantation.