Brazilian Journal of Cardiovascular Surgery
Print version ISSN 0102-7638
COSTA, Roberto et al. Permanent endocardial pacemaker in the first decade of life. Rev Bras Cir Cardiovasc [online]. 1986, vol.1, n.2, pp.15-19. ISSN 0102-7638. http://dx.doi.org/10.1590/S0102-76381986000200004.
Pacemaker implantation in children represents a challenge due to the lack of flexibility of the existing system in relation to the growth of the patients to difficulties in choosing the best place to insert the pulse generator and to technical and social problems as well. Even in Services where the first option should have been the endocardial via, the epicardial implantation has been employed in low weight children. At the INCOR - USP, from November 1980 to October 1985, there were 21 endocardial pacemaker implantations in children at the first decade of their lives. The implantation technique consists of lead insertion through the femoral vein, leaving a loop in the right atrium and placing of the pulse generator in the illiac region. After few years, when the growth of the patient has stretched the lead, the child is reoperated to liberate more leak and to form a new loop, thus allowing the use of the same system for a very long period. The age of the patients varied from 2 months to 10 years. Thirteen of the 21 children were less than 5 years old, and 5 were in their first year of life. The predominant indication was 3rd. degree A-V block (90%), which in 75% of the cases was postoperative. In the follow-up period - three to 63 months and mean of 26 months - 3 patients died from causes unrelated to the pacemaker; the remaining patientsare well. Five children have been reoperated on to liberate the lead from the pulse generator pocket and to form a new loop in the atrium. The advantages of this technique were observed in the follow-up, as compared to epicardial and conventional endocardial implantation. They include: 1) easiness of the technique, with minimal surgical trauma and virtually uneventfull postoperative course; 2) no need of other kind of prosthesis to house the lead; 3) safe follow-up the child with a single radiographic study; 4) preservation of the superior cava system to be imployed in adult life; 5) adequate social integration of the child, who can engage in sports and enjoy a normal childhood without the pacemaker being noticed by others.
Keywords : pacemakers, permanent, endocardial; pacemakers, cardiac.