VDD-Pacemaker in Children - A Long-Term Therapy?

Abstract

Aims: Transvenous AV-synchronous pacing in children started with the invention of smaller sized VDD leads and miniaturization of pacemakers. Whether or not this is a favourable long-term therapy was retrospectively investigated by us based on data from our records. Methods: From May 1977 to July 2001 we implanted pacemakers in 104 children younger than 15 years of age. In 55 patients transvenous leads were implanted. Twelve of these (21.8 %) received a VDD pacemaker for hemodynamic reasons. Results: Ages ranged from 11 months to 14.5 years (mean 7.7 ± 4.3 y). Sizes of the children ranged from 67 to 141 cm (mean 105.9 ± 15.5 cm) and body weight ranged from 5.3 to 62.0 kg (mean 22.5 ± 9.8 kg). The mean follow-up period was 47.5 ± 15.1 months. In 86.3 % of the time during follow-up pacemakers of which we obtained data were working in the VDD mode. Five of the twelve VDD patients (41.7 %) had to be reoperated because of severe traction on the leads. In all five patients the VDD systems were explanted and the patients changed to dual chamber pacemakers. The period of time between implantation and VDD lead explantation ranged from 24 to 74 months (48.6 ± 18.5). Conclusions: VDD pacemakers can be implanted safely even in children with a low complication rate perioperatively. 41.7 % of our VDD patients had to be reoperated within the surveillance time because of severe lead tension due to thoracic growth. In our experience VDD pacemakers in smaller children seem to be a temporary solution to bridge AV-synchrony from a young age to DDD pacing in young adulthood.

Key words

Single lead VDD pacemaker in children - permanent function - reoperation

References

• 1 Markewitz A. Jahresbericht 2000/2001 des Deutschen Zentralregisters der Herzschrittmacher. (Annual report of the German Cardiac Pacemaker Registry).  Herzschr Elektrophys. 2002;  13 242-257
• 2 Frasch W, Bühlmeyer K. Funktionsdauer und Komplikationsrate von Herzschrittmachern im Kindesalter.  Herzschrittmacher. 1981;  1 12-14
• 3 McGrath L B, Gonzalez-Lavin L, Morse D P, Levett J M. Pacemaker system failure and other events in children with surgically induced heart block.  Pace. 1988;  11 1182-1187
• 4 Walsh C A, McAlister H F, Andres C A, Steeg C N, Eisenberg R, Furman S. Pacemaker implantation in children: a 21-year experience.  Pacing Clin Electrophysiol. 1988;  11 1940-1944
• 5 Bullock A, Finley J, Sharrat G, Ross D. Single lead VDD pacing in children with complete heart block.  Can J Cardiol. 1998;  14 58-62
• 6 Rickli H, Brunner-La Rocca H P, Maccarter D J, Duru F, Candinas R. Importance of AV synchronous pacing during low intensity exercise evaluated by oxygen kinetics.  Pacing Clin Electrophysiol. 2000;  23 174-179
• 7 Sparks P B, Mond H G, Vohra J K, Yapanis A G, Grigg L E, Kalman J M. Mechanical remodeling of the left atrium after loss of atrioventricular synchrony. A long-term study in humans.  Circulation. 1999;  100 1714-1721
• 8 Gillette P C, Zinner A, Kratz J, Shannon C, Wampler D, Ott D. Atrial tracking (synchronous) pacing in a pediatric and young adult population.  J Am Coll Cardiol. 1987;  9 811-815
• 9 Ovsyscher I E, Katz A, Rosenheck S, Erdman S, Bondy C. Single lead VDD pacing: multicenter study.  Pacing Clin Electrophysiol. 1996;  19 [Pt. II] 1768-1771
• 10 Rey J L, El Ghelbazouri F, Triboullion C. Dual chamber pacing with a single lead system: Initial clinical results.  Pacing Clin Electrophysiol. 1996;  19 1777-1779
• 11 Rosenheck S, Leibowitz D, Sharon Z. Three-year follow-up of atrial sensing efficacy in children and adults with a single lead VDD pacing system.  Pacing Clin Electrophysiol. 2000;  23 1226-1231
• 12 Rosenthal E, Bostock J. VDD pacing in children with congenital complete heart block: advantages of a single pass lead.  Pacing Clin Electrophysiol. 1997;  20 2102-2106
• 13 Rosenthal E, Bostock J, Qureshi S A, Baker E J, Tynan M. Single pass VDD pacing in children and adolescents.  Pacing Clin Electrophysiol. 1997;  20 1975-1982
• 14 Seiden H S, Camunas J I, Fishburger S B. et al . Use of single lead VDD pacing in children.  Pacing Clin Electrophysiol. 1997;  20 19967-19974
• 15 Smith Jr R T. Pacemakers for children. Gillette PC, Garson A Jr Pediatric Arrhythmias: Electrophysiology and Pacing. Philadelphia PA; W. B. Saunders Co. 1990: 532-558
• 16 Bostan O M, Celiker A, Karagoz T, Ozer S, Ozme S. Dual chamber cardiac pacing in children: Single chamber pacing dual chamber sensing cardiac pacemaker or dual chamber pacing and sensing cardiac pacemaker.  Pediatr Int. 2002;  44 635-640
• 17 Gillette P C, Zeigler V, Bradham G B, Kinsella P. Pediatric transvenous pacing: A concern for venous thrombosis?.  Pace. 1988;  11 1935-1939
• 18 Ward D, Jones S, Shinebourne E A. Long term transvenous pacing in children weighing ten kilograms or less.  Int J Cardiol. 1987;  15 112-115
• 19 Lamas G A, Orav J, Stambler B S. et al . Quality of life and clinical outcome in elderly patients treated with ventricular pacing as compared with dual chamber pacing.  N Engl J Med. 1998;  338 1097-1104
• 20 Moller J E, Simonsen E H, Moller M. Impact of continuous quality improvement on selection of pacing mode and rate of complications in permanent pacing.  Heart. 1997;  77 357-362
• 21 Rosenquist M, Brandt J, Schüller H. Long term pacing in sinus node disease: Effects of stimulation mode on cardiovascular morbidity and mortality.  Am Heart J. 1988;  116 16-22
• 22 Janousek J, Vojtovic P, Chaloupecky V. et al . Hemodynamically optimised temporary cardiac pacing after surgery for congenital heart defects.  Pacing Clin Electrophysiol. 2000;  23 1250-1259
• 23 Horrenstein M S, Karpawich P P, Tantengco M V. Single versus dual chamber pacing in the young: non invasive comparative evaluation of cardiac function.  Pacing Clin Electrophysiol. 2003;  26 1208-1211