Vali-asr. Avenue , Tehran, Iran
Background- Permanent abnormalities of the hearts conductive system may lead to hemodynamic disturbances and require pacemaker implantation. Pediatric pacing involves unique challenges because of the patients size, growth and development and the frequent coexistence of congenital structural heart diseases.
Methods- In this study, 97 patients, who received permanent pacemaker implantation from 1991 to 2001, were reviewed retrospectively using patients records. Attention was paid to the implantation type, etiology of pacemaker replacement and the occurrence of any complication related to underlying cardiac structural anomaly.
Results- During a mean follow-up period of 5.3 years (range 1-14 years), 155 operations were performed for pacemaker implantation or replacement. Etiologies for pacemaker implantation acquired atrioventricular block in 55 patients (59.7%), congenital atrioventricular block in 33 patients (34%), malfunction of sinoatrial node in 6 cases, second-degree atrioventricular block in 6 patients and myocarditis in one patient. Epicardial and endocardial pacemakers were implanted for 70 patients (72.2%) and 27 patients (27.8%), respectively. Congenital heart disease was observed in 62 patients (63.9%). In 44 patients, replacement was performed one to three times. Lead malfunction was the reason of pacemaker replacement in 88.7%. Complications were observed in 8% of epicardial and 15% of endocardial pacemaker implantations.
Conclusion- The 4-year survival rate of epicardial and endocardial pacemakers was 44.8% and 53.3%, respectively, but there appeared to be no statistical relationship between the pacemaker type and its survival rate and also the prevalence of complications. Also, congenital heart disease and a simultaneous implantation of pacemaker at the time of corrective surgery did not play as a risk factor in decreasing the pacemaker survival rate. (Iranian Heart Journal 2002, 2003; 3(4)&4(1): 38-43).