经静脉植入埋藏式心脏起搏器治疗儿童房室传导阻滞长期随访分析

Long-term follow-up of permanent transvenous pacemaker for atrioventricular block in children

目的分析房室传导阻滞患儿经静脉植入埋藏式心脏起搏器治疗、随访及并发症处理。方法1992年5月至2013年12月贵州省人民医院心内科安置埋藏式心脏起搏器治疗症状性高度或Ⅲ度房室传导阻滞患儿11例，年龄5～14岁，平均（12．0±2．8）岁，均采用经静脉植入埋藏式心脏起搏器治疗，并随访1～22年（平均6．1年）。结果患儿经头静脉（1例）或锁骨下静脉（10例）途径植入起搏电极，7例植入心室按需型起搏器。4例植入全自动型起搏器，心房起搏电极安置于右心耳或房间隔，4例右心室起搏电极安置于右心室心尖部，7例安置于右心室间隔部。规律随访期内，起搏阈值、感知及阻抗比较差异均无统计学意义（P〉0．05）。1例患儿术后5年发生起搏电极断裂，予更换起搏系统；1例患儿术后3年出现左心功能不全，升级为心脏再同步化治疗后病情缓解。结论在埋藏式心脏起搏器植入、术后随访过程中，需要针对儿童的有关生理、病理特点采取相应的对策。儿童经静脉植入埋藏式心脏起搏器简便易行、安全有效。

Objective To retrospectively analyze the implantation and follow-up of permanent transvenous pacemaker and treatment for complications in children. Methods Eleven children[ aged 5 ~ 14 years old,mean age（12.0±2.8） years old ] underwent implantation of permanent transvenous pacemaker for atrioventricular block between May 1992 and December 2013 in Department of Cardiology, Guizhou provincial People＇ s Hospital and were followed up for 1 - 22 years （mean 6.1 years）. Results VVI/VVIR were implanted in 7 cases, DDD/DDDR in 4 cases; the endocardial leads were implanted via cephalic vein in only one case and via subclavian vein in other cases.The atrial leads were placed in the right auricle or interatrial septum; the right ventricular leads were positioned in the right ventricular apex in 4 eases and the right ventricular septum in 7 cases.There were no significant differences in pacing thresholds, impedance or R/P-wave amplitude （P 〉 0.05）.The ventricular lead fracture was found at the 5th year after implantation of WI in one case,and then a new lead and pacemaker was reimplanted.Left ventricular dysfunction associated with ventricular pacing was found in one case at the 3rd year after implantation of DDDR, and upgrading to the cardiac resynchronization therapy elevated his ejection fraction. Conclusion Permanent transvenous pacemaker implantation and the follow-up must be in accordance with the physiological and pathological characteristics of children.Implantation of permanent transvenous pacemaker in children is easy, safe and efficient.