Abstract
Pacing is currently the main method of treatment in children with life-threatening bradyarrhythmias. The high-grade atrioventricular block remains the main indication for permanent pacing in children. The factors that determine the specificity of device implantation in the pediatric population are as follows: anthropometric data of a child and their compliance with the size of a pacemaker and the electrodes, the need for long-term (lifelong) cardiac stimulation and multiple replacements of a pacemaker, high level of child’s activity, changes in the physical parameters of the body over time (the need for implantation of the leads “with reserve” and their replacement), and, in some cases, the presence of concomitant congenital heart defects, especially, with intracardiac shunts. One of the controversial issues in pediatric cardiac stimulation is choosing a method of implantation (epicardial or endocardial). According to recent reports, the epicardial lead implantation techniques are increasingly being used because the transvenous pacemakers are associated with more serious complications and due to the capability to choose hemodynamically optimal stimulation zone in epicardial technique to prevent pacemaker-induced dyssynchrony. This approach allows to ultimately postpone the implantation of the endocardial stimulation system, administration of which is associated with the problem of endovascular lead extraction in children, the problem, which has not been resolved not only in Russia but also worldwide. This review article discusses recent literature on the use of permanent pacing in children, including the advantages and disadvantages of using the endocardial and epicardial pacemaker systems as well as various methods of implantation and pacemaker modes most often used in pediatric practice.
Highlights
Cardiac pacing has been introduced into clinical practice decades ago and its use is on the rise in pediatrics [1]
The main reason for cardiac pacemaker implantation in children is the presence of life-threatening bradyarrhythmias such as atrioventricular (AV) block, sick sinus syndrome (SSS), and bimodal pathology, all of which may be either congenital or acquired due to the ongoing or past myocarditis or a complication after surgical correction of congenital heart defects (CHD) [2]
The implantation of a pacing system for permanent stimulation is a common procedure in patients with congenital and acquired heart defects, AV block, and after cardiac surgery even in newborns and young children [3, 4]
Summary
Cardiac pacing has been introduced into clinical practice decades ago and its use is on the rise in pediatrics [1]. Evidence suggests that the number of children and young-age patients with permanent cardiac pacemakers is increased annually, but the number of implanted pacemakers in children including newborns does not exceed 1% of all pacemakers in the world [5] In this regard, the companies producing pacemakers do not intend a further development of special pediatric pacemaker systems so the administration of pacemakers in children requires high professionalism from the specialists facing this problem in clinical practice. Ниже приведены показания для имплантации ЭКС, представленные в данной публикации, у детей с АВБ. Показания к имплантации ЭКС у детей с врожденной АВБ (ВАВБ) 3-й степени: Класс I Полная ВАВБ у новорожденного или младенца с желудочковой частотой ритма менее 55 уд./мин или в сочетании с ВПС и желудочковой частотой ритма менее 70 уд./мин (уровень достоверности доказательств С). Показания к имплантации ЭКС у детей с послеоперационной АВБ: they cannot be used in pediatric practice, they have their own drawbacks when used in clinical practice. Каждый метод имплантации (эпикардиальный и эндокардиальный) имеет свои преимущества и недостатки [16,17,18] (таблица)
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