Long-Term Endocardial Pacing in Children With Postoperative Bradycardia-Tachycardia Syndrome Following the Senning, Mustard and Fontan Operations
Permanent pacing in children, including those with postoperative bradycardiatachycardia syndrome (BTS), remains compromised by devices, lead-electrode systems and implantation technics designed for the adult. Althogh recent technology and simplified implantation technics have reduced many of these barriers, children with congenital anomalies and intra-atrial cardiac operations are particularly prone to postoperative BTS and require special approaches to pacemaker therapy.
This report describes the use of endocardial atrial demand pacing, with antitachycardial burst pacing capabilities (either automatic or parent activated) in the treatment of three children following Mustard repair, one following a Fontan repair, and two following Senning operations. Ages ranged from 3 to 11 years. All had life threatening bradycardias and incapacitating tachyarrhythmias documented clinically. Devices utilized included the Intermedics 262-01 (Cybertach 60) in one patient, and the Medtronic 5984 (Spectrax SX) in five patients. Atrial endocardial pacing was accomplished using the subclavian venipuncture technique and active fixation endocardial leads.
This experience, with a follow-up of 3 to 24 months, suggests that atrial endocardial pacing in children with postoperative BTS and normal A-V nodal function reliably controls symptomatic bradycardia, restores A-V synchrony, appears to decrease the frequency of intra-atrial tachycardia, and with concurrent antiarrhythmic agents provides a means of safe, effective control or termination of tachycardia.
KeywordsAtrial Septal Defect Pacemaker Implantation Sick Sinus Syndrome Pace System Endocardial Lead
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