Pacemaker Implantation in Children: A 21‐Year Experience

Forty‐one children, 20 hoys and 21 girls, aged 11 days to 19 years (mean 9.9 years) at initial pacemaker implant, were followed 1 to 248 months (mean 90 months). Ten (mean age 8.2 years) were implanted between 1966 and 1972 (Group I), 14 (mean age 9.9 years) between 1973 and 1980 (Group 11) and 17 (mean age 10.9 years) from 1981 through April 1988 (Group 111). Arrhythmias were congenital complete heart block in 19, postoperative heart block in 15, acquired heart block in 3, sick sinus syndrome in 3, and bradycardia‐induced ventricular fibrillation in 1. Twenty‐eight of 41 children had a transvenous implant: 40% of Group I, 71% of Group 11 and 82% of Group III. Thirteen were cephalic, four subclavian and 11 jugular. Generator site was pectoral in 19, abdominal in 12, intrathoracic in one, and retromammary in nine of 12 girls aged 10 years or more at implant. In Groups 1,11 and 111, 5, 14 and 6 had VOO or WI units; 5, 0 and 8 dual chamber (VAT, VDD and DDD) pacemakers; 0, 0 and 1 AAI; and 0, 0 and 2 rate‐modulated (WIR) units at initial implant. The average interval between pacer‐related hospitalizations in Groups I, II and III was 20, 42, and 39 months. Complications included infection in six, hemothorax in one, and impending pacemaker erosion in one. Six patients died, one of pacer infection, four from primary cardiac disease, and one suddenly without apparent reason. Follow‐up continues in 31: 14 are employed full‐time, three are homemakers, eight are full‐time students, and six are active pre‐schoolers. Four women have had normal children. We conclude: (1) children with implanted pacemakers can have a normal lifestyle, with prognosis based on underlying cardiac disease; (2) elective epicardial electrodes are now rarely needed; (3) implantation via the cephalic vein is feasible and complication‐free; (4) retromammary implant is technically easy and cosmetic; (5) dual chamber and rate‐modulated pacemakers can be utilized effectively.(PACE, Vol. 11 November Part II 1988)