Dual-chamber epicardial pacing in neonates with congenital heart block
Dual-chamber epicardial pacing in neonates with congenital heart block
复制标题
DOI：
10.1016/j.jtcvs.2007.04.049
复制
发表时间：
2007-11-01
影响因子：
6
通讯作者：
Mavroudis, Constantine
中科院分区：
文献类型：
--
作者：
Kelle, Angela M.;Backer, Carl L.;Mavroudis, Constantine
目的：本综述评估了使用双腔起搏器治疗新生儿先天性心脏传导阻滞的治疗策略的结果。方法：从1989年到2006年，10名新生儿因先天性心脏传导阻滞而植入双腔心外膜起搏器。平均年龄和体重分别为4.4 ± 5.6天和2.8 ± 0.6 kg。4例患者有内脏异位综合征，需要同时进行心脏手术。1例患者有胎儿水肿、心肌炎和心肌病。5例患者心脏结构正常。所有患者均采用胸骨切开术（2例部分，8例完全）和单极电极导线（2例非类固醇洗脱，18例类固醇洗脱）。将发生器放置在肌下双侧腹直肌鞘袋中。结果：所有患者均成功建立了房室同步。平均P波感知为4.7 +/- 2.6 mV，心房电压阈值为0.8 +/- 0.3 V。平均R波感知为13.0 +/- 5.7 mV，心室电压阈值为0.9 +/- 0.5 V。无伤口并发症或急性电极导线故障。中位术后住院时间为14天。4例异位症患者中有3例在术后3天、14天和15个月死亡。心肌病患者在急性心肌炎6个月时突然死亡。无心脏结构正常的患者死亡（P <0.05）。存活者的平均随访间隔为6.1 +/- 7.1年，1例患者失访。结论：在先天性心脏传导阻滞的新生儿中植入双腔心外膜起搏器在技术上是可行的，并且在心脏结构正常的患者中结局良好。6年的系统寿命非常出色。先天性心脏传导阻滞和异位综合征的患者，尽管有双腔起搏，预后仍很差。
Objective: This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block.Methods: From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 +/- 5.6 days and 2.8 +/- 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets.Results: Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 +/- 2.6 mV and atrial voltage threshold was 0.8 +/- 0.3 V. Mean R-wave sensing was 13.0 +/- 5.7 mV and ventricular voltage threshold 0.9 +/- 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 +/- 7.1 years with 1 patient lost to follow-up.Conclusions: Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.