Pediatric Epicardial Devices: Early and Midterm Outcomes.

IF 1.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Elaine M Griffeth, Prasad Krishnan, Joseph A Dearani, Siddharth Pahwa, Michael J Ackerman, Philip L Wackel, Austin Todd, Bryan C Cannon
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引用次数: 0

Abstract

Background: Lead performance is suboptimal in young patients and a main cause of device system failure. Our objective was to assess early and midterm outcomes after epicardial device implantation in a contemporary pediatric cohort.

Methods: A total of 116 consecutive pediatric patients underwent 137 epicardial device implantations from 2010 to 2019. Forty pacemakers and 97 implantable cardioverter defibrillators (ICDs) were implanted. Lead failure was defined as leads repaired, replaced, or abandoned due to fracture, dislodgement, or dysfunction. Freedom from device system failure was determined using Kaplan-Meier analysis.

Results: Mean age at implantation was 10 ± 5 years, 46 (34%) were younger than 8 years old, 41 (30%) had prior cardiac surgery, and 38 (28%) had prior devices. Main indications were acquired heart block (17/40 [43%]), sinus node dysfunction (14/40 [35%]), and congenital heart block (7/40 [18%]) for pacemakers, and hypertrophic cardiomyopathy (46/97 [47%]), long QT syndrome (31/97 [32%]), and ventricular arrhythmia (17/97 [18%]) for ICDs. There were no early deaths. Three-year freedom from device system failure was 80% (95% CI 73%, 88%) for all patients and 88% (95% CI 79%, 99%) for patients <8 years old. Device system failure causes included lead fracture (20/34 [59%]), lead dysfunction (5/34 [15%]), lead dislodgement (5/34 [15%]), infection (3/34 [9%]), and pericarditis (1/34 [3%]). Reintervention was required in 26/34 (76%) device system failures.

Conclusions: Epicardial device implantation is safe, shows acceptable midterm outcomes in children, and is an effective option in patients younger than 8 years old. Close device surveillance continues to be essential to detect lead failure early and ensure timely reintervention.

小儿心外膜装置:早期和中期结果
背景:年轻患者的导联性能不理想,是设备系统故障的主要原因。我们的目标是评估当代儿科患者心外膜装置植入术后的早期和中期预后:从 2010 年到 2019 年,共有 116 名连续的儿科患者接受了 137 次心外膜装置植入手术。其中植入了 40 个起搏器和 97 个植入式心律转复除颤器 (ICD)。导联故障的定义是导联因断裂、脱落或功能障碍而被修复、更换或放弃。采用 Kaplan-Meier 分析法确定设备系统无故障情况:植入时的平均年龄为 10 ± 5 岁,46 人(34%)小于 8 岁,41 人(30%)曾接受过心脏手术,38 人(28%)曾使用过装置。起搏器的主要适应症为获得性心脏传导阻滞(17/40 [43%])、窦房结功能障碍(14/40 [35%])和先天性心脏传导阻滞(7/40 [18%]),ICD的主要适应症为肥厚型心肌病(46/97 [47%])、长QT综合征(31/97 [32%])和室性心律失常(17/97 [18%])。无早期死亡病例。所有患者三年内无装置系统故障的比例为 80%(95% CI 73%,88%),患者无装置系统故障的比例为 88%(95% CI 79%,99%):心外膜装置植入是安全的,在儿童中显示出可接受的中期结果,是 8 岁以下患者的有效选择。严密的装置监测对于及早发现导联失效和确保及时再干预仍然至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.80
自引率
11.10%
发文量
128
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