| Background:With the rapid development and improvement of cardiac pacing therapy, the number of pacemakers used in children is growing for its small size, light quality, long lifespan and high intelligence. However, the proportion of pacemaker implantation in children is very small, about 1%. Children grow fast, with small size and thin wall heart wall. Besides, basic causes of children differ from those of adult. As a result, it is quite important to choose proper electrode, pulse generator, pacing site and carry out regular follow-up. Research associated with clinical significance and long-term prognosis in children is rare, which lags far behind adults.Objective:This study is to analyze the clinical data of the pediatric patients implanted with endocardial permanent pacemaker in our hospital, and investigate the clinical effects of pediatric patients after implantation of endocardial permanent pacemaker and long-term prognosis.Subjects and Methods:Subjects:A total of 24 children at Shandong Provincial Hospital Affiliated to Shandong University between March 2004 and June 2015 were included in this retrospective study. The electrocardiography, chest roentgenograms and echocardiography and Doppler were examined before operation and after one, three, six and twelve months and every half year after implantation.Methods:We collected the baseline demographic and clinical information by using the electronic medical records. Detailed information was collected during routine follow-up at the clinic. Also, we tested and analyzed the parameters of pacemakers by repetitive measure analysis of variance. A P value of<0.05 was considered statistically significant.Results:1. Permanent pacemakers were implanted into 24 children,12 boys and 12 girls. The ages ranged from 1.3 years to 17.1 years, the average age was (8.1±3.4) years. The weight ranged from 9.5kg to 59kg, the average weight was (26.1±13.9) kg. The length of hospital stay (LOS) ranged from 8 days to 55 days, the average LOS was (24±12) days.2. Primary diseases of nine children were Ⅲ-degree atrioventricular block (AVB), six were myocarditis (MC), five were congenital heart diseases (CHD), three were sick sinus syndrome (SSS), and one was endocardial elastic fiber hyperplasia (EFE). Twelve cases were accompanied by Adams-Stokes syndrome (ASS), eighteen cases had heart enlargement. Total heart rate of 24 hours was 44240-93670 beats,68982 beats on average. Average heart rate of 24 hours was 32-70 beats per min,49 beats per min on average.3. All the 24 patients were implanted with endocardial permanent pacemakers by percutaneous subclavian vein puncture. Children under 12 years old were under condition of total intravenous anesthesia, Children over 12 years old were under local anesthesia. The puncture point was one centimeter just under the inferior border of the middle of the clavicle. The pacemakers were implanted under ectopectoralis or subcutaneous tissue. The electrodes were fixed in right ventricular apex or right ventricular outflow tract septum. The leads were reserved one or half circle in the right atrium. All patients were given preventive use of antibiotics before and during implantation.4. The operation success rate was 100%. Twenty-six person-times were implanted with permanent endocardial pacemakers, twenty-five person-times were single chamber pacemakers, one person-time was dual chamber pacemaker, twenty-four person-times were operated under condition of total intravenous anesthesia, two person-times were under local anesthesia, twenty-four person-times were by puncture below the left clavicle, two person-times were by puncture below the right clavicle, twenty-one pacemaker electrode leads were inactive fixation pacing leads, five were active fixation pacing leads. Ventricular pacing, ventricular sensing, inhibition response and rate adaptive (VVIR) mode devices were in twenty-three person-times. Ventricular pacing, ventricular sensing and inhibition response (VVI) mode devices were in two person-times. Autonomic dual chamber pacing (DDD) was in one person-time. Twenty-three electrodes were fixed in right ventricular apex, two electrodes were in right ventricular outflow tract septum, one dual chamber electrode was in right ventricular apex and left auricle. Twenty pacemakers were implanted under left ectopectoralis, two under right ectopectoralis, and four were under subcutaneous tissue. Twenty-two leads were reserved one circle in the right atrium, four leads were reserved half circle. All patients were given preventive use of antibiotics before and during implantation.5. The follow-up time was 1 month to 11.3 year, average (4.3±3.8) year, with a follow-up rate of 91.7%. The clinical symptoms and the laboratory parameters of these patients were improved during follow-up except that one case had cardiac dilatation.6. Three pacemakers were replaced 8 years,8 years 10 months,10 years 4 months after operation respectively, actual life was prolonged by 8.7 months on average than expectancy.7. The threshold increase 1 week after operation, become stable 3 months after operation, and increase again 5 years after operation. Difference could be found in threshold between the fifth year after the implantation and every other stage. The sensitivity decrease 1 week after operation, become stable 3 months after operation. The sensitivity was significantly different between the duration of operation and each stage after implantation. The impedance decrease 1 week after operation, become stable 3 months after operation, and increase again 5 years after operation. Significantly difference could be found between the duration of operation and each stage after implantation.8. Complications happened to 4 children, two cases had pocket infection-erosion, reset a permanent pacemaker to the contralateral side of the chest after invalid conservative treatment. One case had increase of threshold of pacemaker, of which the lead was refixed. One case had pain in neck and shoulder because of rapid growth, whose pacemaker was to be replaced considering that life of original pacemaker had been reached.Conclusion:1. The operation success rate pacemaker implantation of children is high, safe, effective, and with rare complications. Most children could resume normal activities and go to school. The children’s quality of life was improved.2. Both the threshold and impedance increased five years after operation, so we should improve the test frequency of pacemaker especially five years after operation so that we can get to know the function of the pacemaker. |
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