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).‎