Abstract
Four areas of improvement in pacemaker (P) design and application provide the potential for more effective permanent pacing: 1. Use of lithium power source (LP); 2. Use of rechargeable batteries (RP); 3. the use of atrial epicardial leads (AP) for sick sinus syndrome (SSS); and 4. atrial sequential pacemaker (ASP) for use in complete AV block (CAVB) when atrial augmentation of cardiac output is needed. The purpose of this report is to present the experience in 20 pts, 8 days to 24 years, mean 11 years of age, using these new pacing techniques. The treatment has been evaluated with respect to desired result, duration of effectiveness and acceptability to the patient and parents. Lithium AP was used successfully in 3 pts with SSS and normal AV conduction, although 1 pt still has intermittent tachydysrhythmias. Ventricular P were used in 2 pts with SSS and abnormal AV conduction and in 13 pts with CAVB. There were 11 LP and 4 RP, all of which have functioned without a battery failure; duration of use: LP 1-31 mos, mean 13.7 mos, and RP: 21-37 mos, mean 27.3 mos. Pacing has been effective with complications in only 2 pts: asymptomatic diaphragmatic stimulation. ASP was used in 2 pts with CAVB and congestive heart failure. Both ASP failed to sense atrial depolarization and functioned as fixed-rate ventricular P.
LP and RP offer a durable power source acceptable for pediatric pts needing atrial or ventricular permanent pacing. ASP has not yet proven to work efficiently.
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Pinsky, W., Gillette, P. & Mcnamara, D. ADVANCES IN PERMANENT PACING. Pediatr Res 11, 397 (1977). https://doi.org/10.1203/00006450-197704000-00167
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DOI: https://doi.org/10.1203/00006450-197704000-00167