Cause of Placement of Permanent Epicardial-pacemaker During Peri-operative Period and Long-term Follow-up Study in Patients With Congenital Heart Disease / 中国循环杂志

ABSTRACT

Objective: To analyze the 10-year experience for placement of permanent epicardial-pacemaker (PM) during peri-operative period in a single center of patients with congenital heart diseases (CHD). Methods: A total of 33 CHD patients who received the placement of epicardial-PM during peri-operative period in our hospital from 2002 to 2013 were retrospectively analyzed. There were 6 patients with congenital atrio-ventricular block (AVB) 27 with iatrogenic AVB. All patients were younger than 8 years and the mean age was (23.2 ± 26.9) months, with the body weight at (9.7 ± 5.6) Kg. 6 patients with congenital AVB received surgical PM placement combined with CHD repair, and the other 27 patients received PM placement at (26 ± 13.1) days after the surgery. Steroid-eluting bipolar epicardial pacing leads were inserted through median sternotomy and connected to various pulse generators within the subrectus pocket. The time, type, acute ventricular stimulation sensing, impedance and electrophysiological information of PM were collected during the operation. The patients were followed-up for (46.8 ± 33.9) months for echocardiography, ECG, programming information of PM, and the major adverse cardiac events (MACE) were recorded. Results: There were 2 congenital AVB patients received dual chamber PM and the rest patients received single chamber PM. Acute ventricular stimulation sensing was (1.34 ± 0.72) V, no signiifcant increase was identiifed in the last follow-up examination as (1.37 ± 0.81) V,P=0.93. Compared with immediate PM implantation, no signiifcant increases were observed for impedance and R wave in the last follow-up examination as (366.7 ± 88) Ω vs (331.9 ± 95.9) Ω,P=0.32 and (12.3 ± 3.5) mV vs (11.4 ± 4.9) mV,P=0.635 respectively. There were 4 patients received PM replacement because of generator dysfunction, 7/33 (21.2%) of patients had MACE as heart failure or sudden death. The age and body weight in MACE patients were similar with the patients with good prognosis,P>0.05. No pocket infection or lead fracture occurred. Conclusion: Iatrogenic high level of AVB has been the primary reason for surgical placement of epicardial PM in CHD patients during peri-operative period. It has better long term outcome, while the type of PM should be optimized.