Dual-chamber epicardial pacing in neonates with congenital heart block

Angela M. Kelle, Carl L. Backer, Sabrina Tsao, Robert D. Stewart, Wayne H. Franklin, Barbara J. Deal, Constantine Mavroudis

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective: This review evaluates the outcome of a treatment strategy using dual-chamber pacemakers for neonates with congenital heart block. Methods: From 1989 to 2006, 10 neonates had dual-chamber epicardial pacemaker placement for congenital heart block. Mean age and weight were 4.4 ± 5.6 days and 2.8 ± 0.6 kg. Four patients had heterotaxy syndrome and required concomitant cardiac procedures. One patient had fetal hydrops, myocarditis, and cardiomyopathy. Five patients had structurally normal hearts. Sternotomy (2 partial, 8 full) and unipolar leads (2 non-steroid eluting, 18 steroid-eluting) were used in all. Generators were placed in submuscular bilateral rectus sheath pockets. Results: Successful atrioventricular synchrony was established in all patients. Mean P-wave sensing was 4.7 ± 2.6 mV and atrial voltage threshold was 0.8 ± 0.3 V. Mean R-wave sensing was 13.0 ± 5.7 mV and ventricular voltage threshold 0.9 ± 0.5 V. There were no wound complications or acute lead failures. Median postoperative stay was 14 days. Three of the 4 patients with heterotaxy died at 3 days, 14 days, and 15 months postoperatively. The patient with cardiomyopathy died suddenly at 6 months of acute myocarditis. No patient with a structurally normal heart died (P < .05). Mean follow-up interval in survivors is 6.1 ± 7.1 years with 1 patient lost to follow-up. Conclusions: Implantation of a dual-chamber epicardial pacemaker in neonates with congenital heart block is technically feasible and results in excellent outcomes in patients with structurally normal hearts. System longevity at 6 years is excellent. Patients with congenital heart block and heterotaxy syndrome have a poor prognosis despite dual-chamber pacing.

Original languageEnglish (US)
Pages (from-to)1188-1192
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume134
Issue number5
DOIs
StatePublished - Nov 1 2007

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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