1. Long-term outcome of permanent epicardial pacemaker implantation in neonates: Experience from an Indian center.
- Author
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Bhattacharya, Deepanjan, Namboodiri, Narayanan, Mohanan Nair, Krishna Kumar, Dharan, Baiju S., Sasikumar, Deepa, Gopalakrishnan, Arun, Krishnamoorthy, K. M., Menon, Sabarinath, Ramanan, Sowmya, and Baruah, Sudip Dutta
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CONGENITAL heart disease , *INFANT mortality , *TREATMENT effectiveness , *EVALUATION of medical care , *MEDICAL device removal , *DESCRIPTIVE statistics , *LONGITUDINAL method , *HEART beat , *SURGICAL complications , *VENTRICULAR dysfunction , *CARDIAC pacing , *CARDIAC pacemakers , *HEALTH facilities , *CARDIAC surgery , *PATIENT aftercare , *CHILDREN - Abstract
Introduction: Permanent pacemaker implantation (PPI) in neonates is challenging with respect to indications, device selection, implantation technique, and long-term outcomes. Complex anatomy, the need for long-term pacing with high rates, and a problematic postoperative period are the major problems. Methods: We prospectively followed up 22 newborns who underwent PPI below 28 days of life at our institute. Results: The median age at implantation was 2 days (interquartile range 1-9 days), and 9% were born preterm. The average heart rate before implantation was 46.4 ± 7.2 bpm. Maternal lupus antibodies were positive in 8 (36.4%) neonates, whereas 11 (50.0%) had associated congenital heart disease. Nineteen neonates underwent single chamber (VVI) and three underwent dual chamber (DDD) pacemaker implantation. Over a median follow-up of 46 months (range 2-123 months), the average ventricular pacing percentage was 87.5 ± 24.9%, with a stable pacing threshold. Seven children underwent pulse generator replacement due to battery depletion at a median age of 47 months. Pacing-induced ventricular dysfunction was seen in five children at a median age of 23.6 months, and two underwent upgradation to cardiac resynchronization therapy. Overall mortality was 13.6%, all due to tissue hypoperfusion and lactic acidosis in the postimplantation period. Conclusions: PPI in neonates has a favorable outcome with excellent lead survival. Overall mortality is 13.6%, which is predominantly in the postimplantation period and related to myocardial dysfunction. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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