永久心脏起搏治疗对儿童患者长期预后的影响

目的 了解儿童患者接受永久心脏起搏治疗的安全性及有效性,并评价其长期预后.方法 收集1977年4月1日至2011年4月1日在阜外心血管病医院接受永久心脏起搏治疗的所有患儿（≤14周岁）的临床资料.了解儿童起搏患者的基础心脏疾病、起搏器植入适应证、并发症情况以及长期预后.结果 85例患儿（男52例,女33例）接受永久心脏起搏治疗,年龄2个月～14岁,平均（8.1＆#177;4.2）岁;最常见的基础心脏疾病为先天性心脏病50例（58.8％）,其次为病毒性心肌炎8例（9.4％）,4例（4.7％）患儿合并其他基础心脏疾病（长QT综合征,室性心动过速和肥厚型心肌病）,23例（27.1％）患者无伴发疾病.起搏治疗适应证分别为房室阻滞（67例,78.8％）、病态窦房结综合征（16例,18.8％）、长QT综合征（2例,2.4％）,房室阻滞的患儿绝大多数（43例,64.2％）为外科修补术后.患儿随访1～291（73＆#177;62）个月,18例患儿失随访,随访率为78.8％.随访期间,20例（29.9％）患儿因电池耗竭更换起搏器.并发症的发生率为11.9％（13例次/109次手术）,包括导线移位（5例,4.6％）、囊袋内感染（5例,4.6％）、血肿（2例）和导线断裂（1例）.3例患儿死亡,基础心脏病均为结构性心脏病.结论 儿童患者植入永久心脏起搏器治疗是安全、有效的.应根据患者的年龄、基础心脏病等情况选择合适的导线植入途径和起搏方式.儿童患者接受起搏治疗的长期预后主要与基础心脏疾病相关.

Effects of permanent cardiac pacing on long-term prognosis in pediatric patients

Objective To evaluate the safety,efficacy and long-term prognosis in pediatric patients （pts） with pacemaker implantation.Methods Between April 1977 and April 2011,85 pts required the implantation of a pacemaker were included at Center of Arrhythmia Diagnosis and Treatment,Fuwai Hospital.Patients were followed up by out-patients clinic.Basic heart disease,indications for pacemaker implantation,agerelated pacing mode and complications were carefully reviewed.Results During 34 years,85 pediatric patients [mean age （8.1 ＆#177;4.2） years,2months-14years] underwent pacemaker implantation.Congenital heart disease was the most common basic heart disease （50 pts,58.8%）,viral myocarditis in 8 pts （9.4%）,another 4 pts （4.7%） with long QT syndrome,ventricular tachycardia and hypertrophelloc cardiomyopathy,in 23 patients there was no associated organic heart disease.About the indications,atrioventricular （AV） block,sinus node dysfunction,and long QT syndrome were found in 78.8% （67 pts）,18.8% （16 pts） and 2.4% （2 pts） patients,respectively.Surgically-induced advanced atrioventricular block （for congenital heart disease） took a major count （43 pts,64.2%）.The mean follow-up period was （73＆#177;62） months,18 pts lost to follow-up,and 20 pts （29.9%） accepted replacement operation for power depletion.Complications occurred 13 times （11.9%）,three patients died,but none related to pacemaker implantation.Conclusion Pacemaker implantation in pediatric patients is generally safe and effective.The choice of lead implantation route and pacemaker mode should be considered base on patients age and weight.The long-term prognosis mainly related to basic heart disease.