904–46 Current Trends in Pediatric Pacing: Report of the Midwest Pediatric Pacemaker Registry

Abstract

The Midwest Pediatric Pacemaker Registry provides a large database from which to characterize the current state of pediatric pacing. Currently 692 patients are registered who have had 871 generators and 944 electrodes implanted. Data has been grouped into two-year periods, the most recent being information from 93–94. The most common indication for initial pacemaker implantation in 93–94 remains surgically induced complete heart block (CHB) accounting for 42% of initial implants. This has remained unchanged since 85–86. The most common structural lesions associated with surgical CHB in 93–94 were atrioventricular septal defect-30%, univentricular heart-21%, aortic valve replacement with annular enlargement (Konno Procedure)-21%. Closure of ventricular septal defects were still associated with surgical CHB (21%), but generally only for inlet septal defects. Surgically related sick sinus syndrome accounted for 20% of initial implants while 35% were due to congenital CHB. The remainder were due to non surgically induced sick sinus syndrome, control of tachyarrhythmias or for bradycardia secondary to antiarrhythmic drug therapy. Dual chamber generators accounted for 42% of generators implanted in 93–94. This is increased over prior periods. Of the single chamber pacemakers implanted, >95% were rate responsive units. Yet, not all were programmed to a rate variable mode. Only 55% were initially programmed to either VVIR or AAIR. The percentage of transvenous implantations has steadily increased reaching 42% of all implantations in 93–94. 52% of endocardial electrodes implanted used passive fixation (38% were steroid eluting) with 38% using active fixation and 10% unknown. 68% of endocardial electrodes were bipolar. 52% of epicardial electrodes implanted were “fishhook” electrodes and 37% were “corkscrew” electrodes. Surgical CHB following complex procedures continues to be the most common reason for pacemaker implantation. Surgically related sick sinus syndrome has shown a gradual increase. There has been a steady increase in the use of the transvenous approach, dual chamber pacemakers, and rate variable pacing.