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Device therapy in children with and without congenital heart disease

Device-Therapie bei Kindern mit und ohne angeborenem Herzfehler

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Abstract

Device therapy in children has undergone several changes over the last few years due to developments in technology as well new approaches to preservation of ventricular function in paediatric pacing, novel data on pacing lead survival, inclusion of cardiac resynchronisation therapy and accumulating experience with the implantable cardioverter–defibrillator. Despite these developments device therapy in children is still associated with significant complications mainly due to patient size, growth and underlying structural heart disease. The amount of available data on therapy outcomes is much smaller than in their adult counterparts and prospective randomized studies are completely missing. Thus device therapy has to be cautiously tailored to individual patient needs having in mind the specific situation of expected decades of treatment. Avoidance of complications and potential harm precluding successful therapy continuation in the future should be one of the main principles.

Zusammenfassung

Die Device-Therapie hat bei Kindern in den letzten Jahren viele Veränderungen durchgemacht. Diese sind vor allem durch Neuerungen in der Technologie, Erkenntnisse über die Erhaltung der ventrikulären Funktion bei Pacing, neue Daten über die Überlebensraten der Schrittmacherelektroden, Einbeziehung der kardialen Resynchronisationstherapie und wachsende Erfahrungen mit implantierbaren Defibrillatoren bestimmt worden. Trotz dieser Entwicklungen ist die Device-Therapie bei Kindern immer noch mit signifikanten Komplikationen verbunden, deren Ursachen hauptsächlich in der Patientengröße, im Patientenwachstum und der Präsenz begleitender struktureller Herzerkrankungen liegen. Die Menge der publizierten Daten ist viel kleiner als bei Erwachsenen und prospektive randomisierte Studien sind nicht vorhanden. Die Device-Therapie muss bei Kindern sorgfältig dem individuellen Patientenbedarf angepasst werden, und zwar unter Berücksichtigung der spezifischen Situation bevorstehender Jahrzehnte einer solchen Behandlung. Vorbeugung von Komplikationen, die eine erfolgreiche Therapiefortsetzung in der Zukunft verhindern oder erschweren, ist eins der wichtigsten Gebote.

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J. Janoušek states that there are no conflicts of interest.

This article does not involve studies on humans or animals.

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  1. Children’s Heart Centre (Dětské kardiocentrum), University Hospital Motol, V Úvalu 84, 150 06, Praha, Czech Republic

    Jan Janoušek MD, PhD

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Janoušek, J. Device therapy in children with and without congenital heart disease. Herzschr Elektrophys 25, 183–187 (2014). https://doi.org/10.1007/s00399-014-0335-5

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  • DOI: https://doi.org/10.1007/s00399-014-0335-5

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