Pacemaker implantation in infants and children for atrioventricular block
Sasaki, T.; Sasaki, T.; Yoshida, H.; Sato, Y.; Kimura, H.; Itoh, I.; Niitu, K.
Nihon Kyobu Geka Gakkai 34(11): 1915-1920
1986
ISSN/ISBN: 0369-4739 PMID: 3819491 Document Number: 283258
Recently, by remarkable technological innovation a sophisticated, high-performance pacemaker has been produced which is smaller in size and has higher reliability and provides rationally designed electrodes of longer durability. Pacemaker implantations were evaluated retrospectively to determine the better suited technic in infants and children for atrioventicular block. The subjects consisted of 6 cases (2 infants and 4 children and 3 males and 3 females) with atrioventricular block. The ages at pacemaker implantation ranged from 5 months to 5 years and 6 months (mean, 2 years and 10 months). A catheter electrode was used in 2 cases and a myocardial one in 5 (one of them was changed to a catheter electrode later). For attachment of myocardial electrode, left anterolateral thoracotomy was used in 2 cases, and median sternotomy was used in 3, and in 2 of them a VDD mode pacemaker was implanted. As an atrial electrode, a hook-form stab-in type was used. As a ventricular electrode a screw-in type was used in 4 and a suture type in 1. The generator was implanted beneath the pectoralis major muscle in 2 with catheter electrode. In 5 with a myocardial electrode, the generator was implanted in extrapleural space in 2 and beneath left rectus abdominis muscle in 3 (which were approached by median sternotomy for electrode attachment). About the intrathoracic implantation, the suppuration of the generator pocket was occurred and difficult to treat in one case. And in another case, frequent bronchitis after implantation seemed to be closely related to intrathoracic generator. The postoperative course in 3 cases with the generator implanted beneath the rectus abdominis muscle was uneventful. In one of them, smooth pacing has been maintained over 9 years with the same electrode. The postoperative evaluation of the 6 cases suggest that for atrioventricular block in infants and children, a VDD mode pacemaker with atrial and ventricular electrodes would be recommended. The electrodes must be attached by median sternotomy and generator pocket must be provided beneath the left epigastric rectus abdomonis muscle.