Transvenous Permanent Pacemaker Implantation in Children and Adolescen

爲了研究經血管心內膜型心律調節器在發育中兒童的應用，我們從1994至1997年收集了10位心律過慢併有症狀的病人；包含五男五女，年齡層從5到17歲（平均13±4歲），並追蹤14到48個月（平均33±14個月）。其中5位病人是完全房室傳導阻斷（3位裝VDD型心律調節器，2位均裝DDDR型心律調節器）。1位是病實症候群合併房室結異常（裝VVIR型心律調節器），1位是肥厚型心肌病變（裝DDDR型心律調節器）。除了其中1位因使用可吸收縫線固定導極發生導極鬆脫並致3個月後節律器失常，其餘的病人均可獲得令人滿意的結果，並證實優於傳統心外膜型心律調節器，有更低的並閾值和更長的壽命。結論：心內膜型永久性心律調節器在年齡大於5歲成長中的兒童是值得推廣的另一種解心律異常的方法，且建議房室結異常的病童應使用符合生理需求的VDD型心內膜心律調節器。

關鍵字

心內膜型心律調節器；完全房室傳導阻斷；病竇症候群； QT延長症候群

並列摘要

In pediatric patients cardiac pacing has been traditionally carried out by the epicardial approach in Taiwan. This study was to define the long-term results of transvenous endocardial pacemaker therapy in growing children. From 1994 to 1997, patients with sympatomatic bradycardia referred for permanent pacemaker were enrolled. Permanent pacemaker was implanted under propofol anesthesia and direct puncture of subclavian vein and creation of prepectoral pocket. A total of 10 patients (5 male, 5female) aged from 5 to 17 years (13±4 yrs), constituted the study population. Follow-up period ranged from 14 to 48 months (29±14 months). Underlying rhythm disturbances and pacemaker type implanted were: complete atrioventricular (AV) block 5 (VDD pacemaker in 3 and VVIR in 2), sick sinus syndrome 2 (DDDR pacemaker in both), sick sinus syndrome with abnormal AV conduction 1 (VVIR), long QT syndrome 1 (VVIR) and hypertrophic cardiomyopathy 1 (DDDR). Pacemaker dysfunction occurred in only one patient in whom the endocardial lead was fixed by absorbable thread with an aim to have more flexibility of the lead. The endocardial lead was dislodged but properly reimplanted about 3 months after the initial implantation. All patients had satisfactory lead sensing and pacing threshold during the long- term follow-up. The pacing threshold was much better than that usually needed for epicardial leads. With growing, none have the problems of lead length. Quality of life was reported to be improved in all. Tranvenous permanent pacemaker implantation is feasible in children aged 5 or older The long-term efficacy is satisfactory. Physiological pacing using a single lead (VDD) is recommended for younger patients with impaired AV conduction.

並列關鍵字

Transvenous Pacemaker ； complete AV block ； sick sinus syndrome ； long QT syndrome

國際替代計量

Transvenous Permanent Pacemaker Implantation in Children and Adolescen

全文下載

主題瀏覽