儿童心脏起搏治疗进展

Progress of cardiac pacing in children

随着起搏技术的发展，儿童起搏器病例数不断增多。儿童心脏小而壁薄，生长发育快，基础疾病构成与成人不同，选择适当的电极、脉冲发生器、起搏位点及术后长期随访非常重要。心外膜电极一般应用于小婴儿；心内膜电极寿命长、创伤小、阈值稳定，已成为主导的植入方式。研究表明，右室起搏可导致左心功能降低，左室起搏相对于右室起搏更为生理性。对于起搏系统感染，去除整个起搏系统极其必要。起搏阈值增高、电极相关并发症较常见于心外膜起搏。静脉闭塞、三尖瓣反流等并发症较常见于心内膜起搏。近年发展起来的起搏技术有远程监测系统、心脏再同步治疗、磁共振成像兼容性起搏系统、无导线起搏器等，为儿童心脏起搏治疗提供新策略。

With the rapid development of cardiac pacing therapy, the number of pacemakers used in children is growing. Children grow fast, with small size and thin wall heart wall. Underlying diseases in children are different from those in adults. As a result,it is quite important to choose proper electrode, pulse generator, pa- cing site and carry out regular follow-up. Epicardial electrodes are usually used in infants, while endocardial ones have been the leading choice due to long lifespan, minimal injury and stable threshold. Many studies indicate that fight ventricular pacing can damage left ventricular function and left ventricular pacing is more physiological. It is essential to remove the entire pacemaker system once the diagnosis of pocket infection is made. Elevation of pacemaker threshold and electrode-related complications are more common in epicardial pacemakers while ve- nous occlusion and tricuspid regurgitation are more common in endocardial pacemakers. In recent years, there is progress in remote monitoring system, cardiac resynchronization therapy, magnetic resonance imaging pacemak- ers and leadless pacemakers, which might be promising therapies in the near future.