TY - JOUR
T1 - Dual-chamber epicardial pacing in neonates with congenital heart block
AU - Kelle, Angela M.
AU - Backer, Carl L.
AU - Tsao, Sabrina
AU - Stewart, Robert D.
AU - Franklin, Wayne H.
AU - Deal, Barbara J.
AU - Mavroudis, Constantine
PY - 2007/11
Y1 - 2007/11
N2 - 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.
AB - 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.
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U2 - 10.1016/j.jtcvs.2007.04.049
DO - 10.1016/j.jtcvs.2007.04.049
M3 - Article
C2 - 17976448
AN - SCOPUS:35548957726
SN - 0022-5223
VL - 134
SP - 1188
EP - 1192
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 5
ER -