Special notice about pacemaker implantation in infants and its follow-up study

Abstract

Objective Retrospective analysis of pacemaker implantationsites and the follow-up results of its complications and treatment in infants. Methods Infants who implanted pacemakers between Apr. 2000 and Dev. 2011 were included in this study. Endocardial or epicardial pacing was selected based on the patients' condition, age and weight, infants with pathologic sinus syndrome were implanted AAI or VVI pacing model, endocardial pacing was used in patient with congenital complete atrioventricular block, the lead was advanced into right ventricle through subclavian or internal jugular vein, infants with Ⅲ-AVB were often advised to implant epicardial pacing model postoperatively. Antibiotics were used for about 5 days after operation, and then babies were discharged without any complication. In such patients, electrocardiogram, X-ray and echocardiogram examination, and programmed control of pacemaker should be noticed and follow-up study should be conducted. Results Permanent pacemakers were implanted into 46 infants, 29 boys and 17 girls, the average age was (1.57±0.89) years, the average weight was (10.93±3.34) kg, 17 cases with endocardial pacing model and 29 cases with epicardial pacing, 45 cases with single chamber pacing and only 1 case with dual chamber pacing, 2 infants were combined with ASD and 2 with PDA, all of them were closed the defects firstly and then implanted pacemaker. Thirty-six patients were included in the follow-up study, the average follow-up time 4.86 years. New pacemakers were implanted because of battery exhaustion in 13 infants and 7 leads were changed because of lead shifting; the lead was extracted from a baby with D-trans position of great arteries(D-TGA)/VSD after the recovery from atrioventricular conduction 21 days postoperatively. Superficial wound infections, and then wound dehiscence, presented in two babies after one or three months postoperatively; heart failure was found in one patient by 8-year-follow-ups ; endocardial pacing with DDD model replaced epicardial pacing in 3 patients; and pacing model VVI was replaced by pacing DDD in 3 cases. Conclusions The implantation of pacemaker in infant was safe, effective, with rare complications, the implantation of endocardial or epicardial pacing depends on infants' condition, and wound infection or unstable pacing caused by lead shifting or battery exhaustion should be closely watched. Key words: Infants; Permanent pacemaker; Follow-up; Complication