The Etiological Analysis And Follow-up Observation Of Endocardial Permanent Pacemaker Implantation For Minors

Objective:This article analyses the clinical cases of endocardial permanent pacemaker implantation about our hospital in recent 16 years,and studies the etiology of implanting the endocardial permanent pacemaker for minors and prognosis with different pacing position and mode after implanting pacemaker.Method:We collect and retrospectively analyze the clinical information of 17 cases of minors with endocardial permanent pacemaker implantation of Fujian Provincial Hospital which we collect the date from January 30,2002 to October 5,2017.And we followed up studies parameters such as electrocardiogram,chest radiography,cardiac ultrasound and pacing parameters of pacemaker after implantation.Results:1.Of the 17 minors,there are 8males and 9 females.The age ranged from five months to under 18 years with the average of 9.3 years.2.About the original pathogenesis of permanent pacemaker implantation for minors,seven of them were left III-degree atrioventricular block after viral myocarditis including one was associated with small ventricular septal defect,six of them were III-degree atrioventricular block after complex congenital heart disease surgery including two had experienced the surgery of repairing tetralogy of fallot,two had experienced the surgery of repairing ventricular septal defect,two had been operated on repairing interatrial septum and ventricular septal defect,two of them were unexplained sick sinus syndrome with dilated cardiomyopathy,two were unexplained III-degree atrioventricular block(AVB).3.About clinical symptom of patients,2 patients with sick sinus syndrome and dilated cardiomyopathy were treated with chest tightness and chest pain,one of them was accompanied by amaurosis.Other 15 patients with III-degree atrioventricular block clinical findings,including three patients were dizziness and fatigue,two patients temporary showed convulsion,one occurred syncope recurrent,one showed edema of both lower limbs,one showed cyanotic lips after exercise,and six of which found bradycardia by physical examination.4.In this group all patients underwent permanent pacemaker implantation,the VVI(R)was 10 cases,including 2 cases of ventricular inhibited pacing(VVI)and 8 cases of VVIR.And DDD(R)was 7 cases,including 4 cases of autonomic dual chamber pacing(DDD)and 3 cases of DDDR.Among the patients of VVI(R)mode,5 eletrodes were fixed in the RV apex actively,5 eletrodes were fixed in the RV septum actively.Among the patients of VVI(R)mode,2 eletrodes were fixed in the RV apex inactively,3eletrodes were fixed in the RV apex actively,5 eletrodes were fixed in the RV septum actively.Among the patients of DDD(R)mode,2 cases had inactive fixation leads in RA appendages and RV apical,1 cases had inactive fixation leads in RA appendages and active fixation leads in right ventricular outflow tract(RVOT),2 cases had active fixation leads in RA septum and RV interval,1 case had passive fixation leads in RA and active fixation leads in RV interval,and 1 case had active fixation leads in RA and RV interval.5.All the 17 patients underwent preoperative heart color ultrasound,the left ventricular end-diastolic volume(LVEDV)was 12-133.0ml,(52.89 + 33.04)ml on average.The ejection fraction was 41.0-75.0%,(61.89 + 7.79)% on average.The left ventricular diameter(LVD)was 2.43-5.44 cm,(3.76 + 1.24)cm.The right ventricle diameter(RVD)was 1.60-4.47 cm,(2.77 + 0.79)cm on average.Among the 13 follow-up patients,the ejection fraction was 45-69%,(61.39±6.51)% on average.The left ventricular diameter(LVD)was 2.12-5.86 cm,(4.18±0.93)cm.The right ventricle diameter(RVD)was2.27-4.34 cm,(3.18±0.58)cm on average.There was no different of statistics in LVEDD,RVD and LVEF compare the preoperative and postoperative follow-up of the patients mean 3.1 years.And compare VVI(R)group and DDD(R)group,VVI(R)group had statistical difference between RAD [(2.61±0.21)VS(2.93±0.19);P=0.02] 和RVD[(2.50±0.18)VS(2.86±0.20);P=0.03],and there was no difference in the other cardiac indexes.In addition,compared parts of pacing of apex and ventricular septum,there were no difference of LVED,RVD and LVEF between the preoperative and postoperative.6.Follow-up: There were 13 patients were followed up,and the patients were followed up with pacemaker program.There was within normal limits of the threshold,impedance,and sensitivity of pacing after surgery.The rate of postoperative patients was all pacemaker heart rate through ECG.The pacemakers were well working,without complications such as Adams-Strokes syndrome,pacemaker infection and bleeding,dislocation of electrode lead and broken lead etc.Three patients pacemaker replaced thebattery of pacemaker due to power expires.Conclusion:The main causes of endocardial permanent pacemaker implantation for minors were atrioventricular block resulted in viral myocarditis,followed in atrioventricular block after complexity congenital heart disease surgery,and rare in sick sinus syndrome caused by unknown reason.There should be sufficient reserve for the electrode implanted in the endocardial permanent pacemaker.It is safe and effective for minors to be implanted endocardial permanent pacemaker.The appropriate selection of pacemaker type had no significant effect on the LV structure and function in minors except VVI(R)pacing mode.