EFFECTIVENESS AND MORBIDITY IN CHILDREN WITH CARDIAC PACEMAKERS FOR MORE THAN 10 YEARS

Tipple MA¹, LeBlanc JG¹, Sett S¹, Yeung AFJ², Kerr CR², Tyers GF³

¹BC Children’s Hospital, ²St Paul’s Hospital, ³Vancouver Hospital

Vancouver, British Columbia, Canada

Objective: To determine the long term effectiveness and morbidity of pacing therapy in children, paced for longer than 10 years.

Method: A retrospective analysis of patients attending the pacemaker clinic of BC Children’s Hospital was undertaken to determine the number of pacer interventions, effectiveness of pacing and long term outcome of all patients receiving pacemaker therapy for longer than 10 years.

Results: 63 patients (pts) were followed from 10y–27y (mean 16y 2m). Indications for pacing were: Sick sinus syndrome (SSS) 3, SSS + congenital heart block (CHB) 5, SSS + surgical heart block(SHB) 8, SHB 20, CHB 25, Ventricular tachycardia 1, Syncope 1. 21 pts had normal anatomy, 42 had post-operative CHD. Age at first pacemaker

(pm) insertion ranged from 8m to 17y 4m. 5pts moved and lost to FU. Pts received between 1-7 pm (av X). Interval between pm replacement ranged from 2m-14y 1m (mean 6.6y). Initial method of pacing: epicardial(epi) 42, transvenous(tv) 24; last method: epi 20, tv 43. Initial mode: single chamber (SC) 42, dual chamber (DC) 21; last mode SC 17, DC 46. Significant complications occurred in 13pts: lead fracture (6), lead malposition (1), lead removal (2) and infection (4). 5 pts died of unrelated causes. 44pts had uncomplicated courses. All pts have active lifestyles excluding contact sports. 19 attend school, 9 university, 20 full time employment, 3 homemakers. 5 females had a total of 9 successful pregnancies.

Conclusion: Long term pacing therapy is successful in allowing pts to live productive lives with minimal restrictions. Modern pm technology allows for improved results. Removal and replacement of tv leads remains technically difficult.

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