Epicardial Pacemaker in Neonates and Infants: Is There a Relationship Between Patient Size, Device Size, and Wound Complicatıon?

Long-term outcome of permanent epicardial pacemaker implantation in neonates: Experience from an Indian center

Introduction

Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems.

Methods

We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute.

Results

The median age at implantation was 2 days (interquartile range 1-9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2-123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period.

Conclusions

PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction.

Follow-up Results of Permanent Epicardial Pacing in Children: A 15-Year Retrospective Study.. [DOI: 10.21203/rs.3.rs-2390319/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Permanent epicardial pacing is an effective treatment for pediatric patients especially for those with low body weight, small body size or complex cardiac structures. This study aimed to investigate the follow-up results and identify the associated risk factors of epicardial pacing in children. Method Pediatric patients who successfully received permanent epicardial pacing treatment at Guangdong Provincial People's Hospital from March 2005 to March 2021 were included in this study. The surgical data, echocardiographic examination parameters, incidence of reoperation, and long-term complications of these patients were recorded. Result A total of 139 patients were enrolled in this study. The median follow-up period was 50 months. Compared to a baseline measurement, there was a significant decrease in the postoperative left ventricular end-diastolic diameters. For patients with left ventricular systolic dysfunction, left ventricular ejection fraction and left ventricular fractional shortening significantly improved after implantation. Thirty-one patients (22.3%) had complications in the follow-up period, and the most common was lead failure (14.4%). The reoperation incidence was 33.8%. Right ventricle pacing is a risk factor associated with reoperation. The five-years survival time of leads and batteries were 84.5% and 83.4%, respectively. Right ventricle pacing was the only risk factor which significantly reduced the lifespan of lead and battery. Conclusion Permanent epicardial pacing therapy is an effective treatment in children in spite of postoperative complications. RV pacing is a significant risk factor for reoperation, and it increases the occurrence of complications and reduces the survival time of the lead and battery.

A Broader Perspective on Anti-Ro Antibodies and Their Fetal Consequences-A Case Report and Literature Review

The presence of maternal Anti-Ro/Anti-La antibodies causes a passively acquired autoimmunity that may be associated with serious fetal complications. The classic example is the autoimmune-mediated congenital heart block (CHB) which is due in most cases to the transplacental passage of Anti-Ro/Anti-La antibodies. The exact mechanisms through which these pathologic events arise are linked to disturbances in calcium channels function, impairment of calcium homeostasis and ultimately apoptosis, inflammation and fibrosis. CHB still represents a challenging diagnosis and a source of debate regarding the best management. As the third-degree block is usually irreversible, the best strategy is risk awareness and prevention. Although CHB is a rare occurrence, it affects one in 20,000 live births, with a high overall mortality rate (up to 20%, with 70% of in utero deaths). There is also concern over the lifelong consequences, as most babies need a pacemaker. This review aims to offer, apart from the data needed for a better understanding of the issue at hand, a broader perspective of the specialists directly involved in managing this pathology: the rheumatologist, the maternal-fetal specialist and the cardiologist. To better illustrate the theoretical facts presented, we also include a representative clinical case.