先天性完全性房室传导阻滞合并房间隔缺损患儿的永久起搏器安装

Implantation of permanent pacemakers for children with congenital complete atrioventricular block and atrial septal defect

目的探讨先天性完全性房室传导阻滞(CCAVB)合并房间隔缺损(ASD)的治疗方法及永久起搏器安装注意事项。方法 3例符合永久起搏器安装指征的CCAVB合并ASD患儿依据年龄、体质量等指标,1例行ASD修补手术后安装心外膜起搏器,2例内科行ASD介入封堵后安装心内膜永久起搏器,起搏模式均为VVI。结果 1例接受ASD修补手术患儿,术中尝试安装心内膜起搏器,但因血管狭小,导线固定困难,后安装心外膜起搏器。术后随访,心内膜起搏均正常;术后2年心外膜起搏无效,诊断为起搏导线移位,重新植入导线后起搏有效。随访心脏超声显示心功能均无明显异常。结论 CCAVB合并ASD患儿符合永久性起搏器安装指征者,需先行ASD治疗。如果患儿年龄小、体质量轻,可选择安装心外膜起搏器,年长儿可先行ASD介入治疗后安装心内膜起搏器,术后起搏器参数无明显差异。心外膜起搏需注意导线固定,心内膜起搏心房内预留导线应避免触及封堵器,以免造成起搏导线磨损发生短路。

Objective To evaluate the treatment method of children with congenital complete atrioventricular block(CCAVB) and atrial septal defect(ASD),and discuss the attention of permanent pacemaker implantation.MethodsBased on age and body weight of 3 children with CCAVB and ASD,1 was implanted with an epicardial pacemaker after repairing ASD by surgical procedure,and 2 were implanted with permanent endocardial pacemakers after interventional procedures for ASD.The model of pacing was VVI for all patients.Results Endocardial pacemaker was attempted to implant in one patient after repairing ASD,while ended up with epicardial pacemaker implantation due to difficulty in lead fastening with small vein.The endocardial pacing was normal during the follow up.However,the epicardial pacing failed two years after follow up due to lead shifting,and was reset after a new lead installation.No abnormality in cardiac function was found by echocardiography during follow up.Conclusion ASD should first be repaired through interventional or surgical procedures in patients with CCAVB and ASD meeting the indications for permanent pacemaker implantation.Epicardial pacemakers can be implanted in young infants with light weight,and endocardial pacemakers can be implanted in old children after interventional procedures for ASD.There is no significant difference in pacemaker parameters between these two pacing models.More attention should be paid to the lead fastening of epicardial pacing and the room between lead and occluder of endocardial pacing to avoid the lead abrasion.