A follow-up analysis of cardiac function and complications in pediatric patients with permanent epicardial pacing
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摘要
Background Nowadays, the number of pediatric patients receiving permanent pacemaker implantations is increasing. However, there is very little relevant, long-term follow-up analysis carried out in China. Methods Clinical information from pediatric patients who underwent epicardial permanent pacemaker implantation from January 1, 2005 to December 31, 2017 in Guangdong Provincial People's Hospital was collected. Eligible patients received 12-lead electrocardiograms and echocardiography preoperatively and postoperatively, as well as programming control during their follow-up. Meanwhile, complications were treated and analyzed. Results A total of98 pediatric patients with permanent epicardial pacing were included in the study, including 60 males and 38 females. The age of patients who underwent surgery for the first time ranged from 8 days to 14 years old( the median age of these patients was 3 years old). The weight of these patients ranged from 2.7 kg to 52 kg(the median weight of these patients was 12 kg). Three patients died while they were getting treatment. The follow-up was carried out on eighty-seven out of ninety-five patients(91.6%) and lasted 5 months to 13 years( average 3.79±3.06 years). One patient with single-chamber right ventricular pacing was found to have cardiac insufficiency in the second year after operation. There were 6 patients with cardiac insufficiency whose ejection fractions were less than 55%. All these patients had a single-chamber left ventricular pacing implant or double-chamber right atrial left ventricular pacing implant. Paired T-test was used to compare the preoperative LVEF with the last echocardiographic LVEF(45%±7% vs.67%±7%, P < 0.05),which indicated statistical differences. Conclusion A permanent epicardial pacemaker is safe and effective and reasonable pacing mode can protect cardiac function.[S Chin J Cardiol 2019;20(1):10-14]
Background Nowadays, the number of pediatric patients receiving permanent pacemaker implantations is increasing. However, there is very little relevant, long-term follow-up analysis carried out in China. Methods Clinical information from pediatric patients who underwent epicardial permanent pacemaker implantation from January 1, 2005 to December 31, 2017 in Guangdong Provincial People's Hospital was collected. Eligible patients received 12-lead electrocardiograms and echocardiography preoperatively and postoperatively, as well as programming control during their follow-up. Meanwhile, complications were treated and analyzed. Results A total of98 pediatric patients with permanent epicardial pacing were included in the study, including 60 males and 38 females. The age of patients who underwent surgery for the first time ranged from 8 days to 14 years old( the median age of these patients was 3 years old). The weight of these patients ranged from 2.7 kg to 52 kg(the median weight of these patients was 12 kg). Three patients died while they were getting treatment. The follow-up was carried out on eighty-seven out of ninety-five patients(91.6%) and lasted 5 months to 13 years( average 3.79±3.06 years). One patient with single-chamber right ventricular pacing was found to have cardiac insufficiency in the second year after operation. There were 6 patients with cardiac insufficiency whose ejection fractions were less than 55%. All these patients had a single-chamber left ventricular pacing implant or double-chamber right atrial left ventricular pacing implant. Paired T-test was used to compare the preoperative LVEF with the last echocardiographic LVEF(45%±7% vs.67%±7%, P < 0.05),which indicated statistical differences. Conclusion A permanent epicardial pacemaker is safe and effective and reasonable pacing mode can protect cardiac function.[S Chin J Cardiol 2019;20(1):10-14]
Background Nowadays, the number of pediatric patients receiving permanent pacemaker implantations is increasing. However, there is very little relevant, long-term follow-up analysis carried out in China. Methods Clinical information from pediatric patients who underwent epicardial permanent pacemaker implantation from January 1, 2005 to December 31, 2017 in Guangdong Provincial People's Hospital was collected. Eligible patients received 12-lead electrocardiograms and echocardiography preoperatively and postoperatively, as well as programming control during their follow-up. Meanwhile, complications were treated and analyzed. Results A total of98 pediatric patients with permanent epicardial pacing were included in the study, including 60 males and 38 females. The age of patients who underwent surgery for the first time ranged from 8 days to 14 years old( the median age of these patients was 3 years old). The weight of these patients ranged from 2.7 kg to 52 kg(the median weight of these patients was 12 kg). Three patients died while they were getting treatment. The follow-up was carried out on eighty-seven out of ninety-five patients(91.6%) and lasted 5 months to 13 years( average 3.79±3.06 years). One patient with single-chamber right ventricular pacing was found to have cardiac insufficiency in the second year after operation. There were 6 patients with cardiac insufficiency whose ejection fractions were less than 55%. All these patients had a single-chamber left ventricular pacing implant or double-chamber right atrial left ventricular pacing implant. Paired T-test was used to compare the preoperative LVEF with the last echocardiographic LVEF(45%±7% vs.67%±7%, P < 0.05),which indicated statistical differences. Conclusion A permanent epicardial pacemaker is safe and effective and reasonable pacing mode can protect cardiac function.[S Chin J Cardiol 2019;20(1):10-14]
引文
1.ZHANG Shu,HUA Wei,HUANG Jia-de,et al.Current knowledge and recommendations of implantable pacemaker therapy(update 2010).Chin J Cardiac Arrhyth2010,14:245-259.
2.ZHANG Wen-bo,YE ming,CHEN Gang,et al.Feasibility and safety of epicardial pacemaker implantation in infants and children.Chin J Pediatr Surg 2015,36:608-610.
3.Balaji S,Sreeram N.The development of pacing induced ventricular dysfunction is influenced by the underlying structural heart defect in children with congenital heart disease.Indian Heart J 2017,69:240-243.
4.Gebauer RA,Tomek V,Salameh A,et al.Predictors of left ventricular remodelling and failure in right ventricular pacing in the young.European Heart Journal 2009,30:1097-1104.
5.Karpawich PP,Rabah R,Haas JE.Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block.Pacing ClinElectrophysiol 1999,22:1372-1377.
6.Ortega MC,Morejón AEG,Ricardo GS.Left Ventricular Synchrony and Function in Pediatric Patients withDefinitive Pacemakers.Arquivos Brasileiros De Cardiologia2013,101:410.
7.LI Xiao-mei,ZHANG Yan,PAN Guang-yu,et al.Left atrial and ventricular epicardial dual chamber pacing through a left lateral thoracotomy to treatpediatric complete atrioventricular block.Chin J Pediatr 2013,8:578-583.
8.Motonaga KS,Dubin AM.Cardiac resynchronization therapy for pediatric patients with heart failure and congenital heart disease:a reappraisal of results.Circulation2014,129:1879-1891.
9.Yu CM,Fung WH,Lin H,et al.Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy.Am J Cardiol 2003,91:684-688.
10.Leclercq C,Faris O,Tunin R,et al.Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block.Circulation 2002,106:1760-1763.
11.Cecchin F,Frangini PA,Brown DW,et al.Cardiac resynchronization therapy(and multisite pacing)in pediatrics and congenital heart disease:five years experience in a single institution.J Cardiovasc Electrophysiol 2009,20:58-65.
12.DeSilvey DL.Minimizing ventricular pacing to reduce atrial fibrillation in sinus node disease.Am J Geriatr Cardiol 2008,17:57-58.
13.ZHAO Peng-jun,LI Fen,LI Jun,et al.Special notice about pacemaker implantation in infants and its followup study.Chin J Appl Clin Pediatr 2013,28:1878-1880.
14.Lichtenstein BJ,Bichell DP,Connolly DM,et al.Surgical approaches to epicardial pacemaker placement:does pocket location affect lead survival?Pediatr Cardiol2010,31:1016-1024.
15.Zeng Shao-ying,LIANG Dong-po.Progress in children.s cardiac pacing therapy.Chin J Heart&Heart Rhythm2015,2:120-126.
2.ZHANG Wen-bo,YE ming,CHEN Gang,et al.Feasibility and safety of epicardial pacemaker implantation in infants and children.Chin J Pediatr Surg 2015,36:608-610.
3.Balaji S,Sreeram N.The development of pacing induced ventricular dysfunction is influenced by the underlying structural heart defect in children with congenital heart disease.Indian Heart J 2017,69:240-243.
4.Gebauer RA,Tomek V,Salameh A,et al.Predictors of left ventricular remodelling and failure in right ventricular pacing in the young.European Heart Journal 2009,30:1097-1104.
5.Karpawich PP,Rabah R,Haas JE.Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block.Pacing ClinElectrophysiol 1999,22:1372-1377.
6.Ortega MC,Morejón AEG,Ricardo GS.Left Ventricular Synchrony and Function in Pediatric Patients withDefinitive Pacemakers.Arquivos Brasileiros De Cardiologia2013,101:410.
7.LI Xiao-mei,ZHANG Yan,PAN Guang-yu,et al.Left atrial and ventricular epicardial dual chamber pacing through a left lateral thoracotomy to treatpediatric complete atrioventricular block.Chin J Pediatr 2013,8:578-583.
8.Motonaga KS,Dubin AM.Cardiac resynchronization therapy for pediatric patients with heart failure and congenital heart disease:a reappraisal of results.Circulation2014,129:1879-1891.
9.Yu CM,Fung WH,Lin H,et al.Predictors of left ventricular reverse remodeling after cardiac resynchronization therapy for heart failure secondary to idiopathic dilated or ischemic cardiomyopathy.Am J Cardiol 2003,91:684-688.
10.Leclercq C,Faris O,Tunin R,et al.Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block.Circulation 2002,106:1760-1763.
11.Cecchin F,Frangini PA,Brown DW,et al.Cardiac resynchronization therapy(and multisite pacing)in pediatrics and congenital heart disease:five years experience in a single institution.J Cardiovasc Electrophysiol 2009,20:58-65.
12.DeSilvey DL.Minimizing ventricular pacing to reduce atrial fibrillation in sinus node disease.Am J Geriatr Cardiol 2008,17:57-58.
13.ZHAO Peng-jun,LI Fen,LI Jun,et al.Special notice about pacemaker implantation in infants and its followup study.Chin J Appl Clin Pediatr 2013,28:1878-1880.
14.Lichtenstein BJ,Bichell DP,Connolly DM,et al.Surgical approaches to epicardial pacemaker placement:does pocket location affect lead survival?Pediatr Cardiol2010,31:1016-1024.
15.Zeng Shao-ying,LIANG Dong-po.Progress in children.s cardiac pacing therapy.Chin J Heart&Heart Rhythm2015,2:120-126.