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| Etiological analysis and follow-up observation of permanent endocardial pacemaker implantation in minor patients |
| LIN Xiaohua, ZHANG Jiancheng,ZHANG Yan |
| (Department of Cardiology, 1. the First Affiliated Fuzhou Hospital of Fujian Medical University, Fuzhou Fujian 350009; 2. Fujian Provincial Hospital, Fuzhou Fujian 350001, China) |
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Abstract Objective To study the etiological composition of permanent endocardial pacemaker implantation in minor patients, and the influence of different pacing locations and modes on cardiac function. Methods We retrospectively analyzed the clinical data of 17 minor patients implanted with permanent endocardial pacemaker. Their ECG, anterolateral radiography of the heart, color Doppler echocardiography and pacing parameters of pacemaker after implantation were followed up. ResultsThe primary disease composition of 17 minors is as follows: 7 cases of third-degree atrioventricular block resulted from viral myocarditis, 6 cases of third-degree atrioventricular block after complex congenital heart disease surgery, 2 cases of unexplained sick sinus syndrome complicating dilated cardiomyopathy and 2 cases of unexplained third-degree atrioventricular block. Classified by the types of implanted pacemakers, there are 10 cases of singlechamber ventricular pacing and 7 cases of dualchamber pacing. The operation goes smoothly in the enrolled patients except for one patient who died of primary disease after the implantation. Thirteen patients are followed up for an average of 3.1 years after the surgery. The pacemaker programmability of these 13 patients are followed up in the outpatient department; VVI(R) pacing mode and DDD(R) pacing mode are separately applied in 7 and 6 patients. Color Doppler echocardiography results show that right atrium diameter (RAD) and right ventricular diameter (RVD) of the cases in VVI(R) pacing mode both significantly increase after the surgery (P＜0.05). There is no statistically significant difference in LVED, RVD and LVEF before and after the operation whether pacing in ventricular apex or septum. There is no difference in the right ventricular pacing threshold, impedance, percentage, and sensitivity 1 year, 2 years and 3 years after the surgery. The pacemakers function well after the operation whithout postoperative complication. Pacemaker battery replacement was performed in 2 patients due to pacemaker battery depletion separately after 7 and 14 years. Conclusion Among the causes of permanent endocardial pacemaker implantation in minors, the dominant one is atrioventricular block resulted from viral myocarditis, followed by atrioventricular block after complex congenital heart disease surgery, and unexplained sick sinus syndrome is rare. In the implantation of permanent endocardial pacemaker, sufficient length of the electrode cable should be reserved. Pacing mode and location show no obvious effect on the left ventricular structure and function.
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