vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-2022-1-05vestar-1056Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESПостоянная электрокардиостимуляция у детей: результаты многолетнего наблюдения, анализ осложненийPermanent pacing in children: results of follow-up, assessment of complicationshttps://orcid.org/0000-0002-3947-4903ДжаффароваО. Ю.DzhaffarovaO. Yu.

Томск, пер. Кооперативный, д. 5

Tomsk, Kooperativnyy lane, 5

oyd@cardio-tomsk.ruhttps://orcid.org/0000-0002-2056-4060СвинцоваЛ. И.SvintsovaL. I.

Томск, пер. Кооперативный, д. 5

Tomsk, Kooperativnyy lane, 5

https://orcid.org/0000-0003-4823-4378ПлотниковаИ. В.PlotnikovaI. V.

Томск, пер. Кооперативный, д. 5

Tomsk, Kooperativnyy lane, 5

https://orcid.org/0000-0003-4823-4378ДамбаевБ. Н.DambaevB. N.

Томск, пер. Кооперативный, д. 5

Tomsk, Kooperativnyy lane, 5

https://orcid.org/0000-0003-2469-8098КартофелеваЕ. О.KartofelevaE. O.

Томск, пер. Кооперативный, д. 5

Tomsk, Kooperativnyy lane, 5

Научно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian Federation2022290320222913238Copyright © Джаффарова О.Ю., Свинцова Л.И., Плотникова И.В., Дамбаев Б.Н., Картофелева Е.О., 20222022Джаффарова О.Ю., Свинцова Л.И., Плотникова И.В., Дамбаев Б.Н., Картофелева Е.О.Dzhaffarova O.Y., Svintsova L.I., Plotnikova I.V., Dambaev B.N., Kartofeleva E.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1056Цель

Цель. Представить опыт и проанализировать осложнения постоянной кардиостимуляции у детей с брадиаритмиями на основе многолетнего наблюдения.

Материалы исследования

Материалы исследования. Проанализированы данные 145 детей со структурно-нормальными сердцами с имплантированными электрокардиостимуляторами (ЭКС) в возрасте от 1 месяца до 18 лет. Период наблюдения - с 1999 по 2020 гг. Эпикардиальная имплантация ЭКС была выполнена 71 ребенку, эндокардиальная - 74. Средний возраст первичной имплантации ЭКС составил 8,67±5,2 лет.

Результаты

Результаты. Выявлены следующие осложнения: гемодинамические осложнения (увеличение камер сердца в динамике и/или развитие внутрижелудочковой и межжелудочковой диссинхронии, появление и нарастание степени регургитации на атриовентрикулярных клапанах), бактериальный эндокардит, гемоперикард, окклюзия подключичной вены, перикардит, инфицирование стимулятора и его ложа, дислокация ЭКС и нарушение целостности электродов. У пациентов с эпикардиальным способом имплантации ЭКС осложнения были выявлены у 24 (33,8%) обследованных, с эндокардиальным - у 37 (50%). Гемодинамические осложнения при эпикардиальной стимуляции связаны с внутрижелудочковой диссинхронией вследствие имплантации желудочкового электрода на боковую стенку или выходной отдел правого желудочка. У пациентов, которым имплантация эпикардиального электрода выполнена в области верхушки левого желудочка (ЛЖ), гемодинамических осложнений не зарегистрировано.

Заключение

Заключение. Дети с имплантированными ЭКС требуют тщательного динамического наблюдения. Наиболее рациональным является применение первичной эпикардиальной системы ЭКС с имплантацией электрода на верхушку ЛЖ, это позволяет сохранить вены для эндокардиальной стимуляции в более старшем возрасте, и предотвратить развитие гемодинамических осложнений. Ни эпикардиальный, ни эндокардиальный способы имплантации ЭКС не гарантируют отсутствие осложнений, однако соблюдение вышеперечисленных условий позволит добиться высокой эффективности и безопасности кардиостимуляции у детей. 

Aim

Aim. To present the experience and assess the complications of permanent pacing in children with bradyarrhythmias based on long-term follow-up.

Methods

Methods. Data of 145 children with structurally normal heart with implanted pacemakers at the age from 1 month to 18 years were retrospectively assessed. The follow-up was from 1999 to 2020 years. Epicardial pacemaker was implanted in 71 children, endocardial - in 74. The mean age of the primary implantation was 8.67±5.2 years.

Results

Results. The following complications were disclosed: hemodynamic complications (heart chamber enlargement in dynamics and/or development of dyssynchrony, the appearance and increase in the regurgitation degree on the atrioventricular valves), bacterial endocarditis, hemopericardium, subclavian vein occlusion, pericarditis, infection of the pacemaker and its pocket, leads dislocation and fracture. With epicardial pacing various complications were detected in 24 (33.8%) examined patients, with endocardial - in 37 (50%). Hemodynamic complications with epicardial permanent pacing are associated with intraventricular dyssynchrony due to implantation of a ventricular lead on the lateral wall or the right ventricular outflow tract. Hemodynamic complications were not recorded in patients that performed the implantation of an epicardial lead at the left ventricular (LV) apex.

Conclusion

Conclusion. Children with pacemakers require careful follow-up. The most rational is the use of a primary epicardial pacemaker system with lead implantation on the apex of the LV. Such approach allows the veins to be preserved for endocardial stimulation at an older age, and to prevent hemodynamic complications. Neither epicardial nor endocardial pacemaker implantation guarantee the absence of complications. However, compliance with the above conditions will allow achieving high efficiency and safety of cardiac stimulation in children. 

электрокардиостимуляцияспособы имплантации электродовосложнениядетиpacingmethods of lead implantationcomplicationschildrenReferencesTakeuchi D, Tomizawa Ya. Pacing device therapy in infants and children: a review. J Artif Organs. 2013;16: 23- 33. https://doi.org/10.1007/s10047-012-0668-y.Takeuchi D, Tomizawa Ya. Pacing device therapy in infants and children: a review. J Artif Organs. 2013;16: 23- 33. https://doi.org/10.1007/s10047-012-0668-y.Welisch E, Cherlet E, Crespo-Martinez E, et al. A single institution experience with pacemaker implantation in a pediatric population over 25 years. Pacing Clin Electrophysiol. 2010;33: 1112-8. https://doi.org/10.1111/j.1540-8159.2010.02781.x.Welisch E, Cherlet E, Crespo-Martinez E, et al. A single institution experience with pacemaker implantation in a pediatric population over 25 years. Pacing Clin Electrophysiol. 2010;33: 1112-8. https://doi.org/10.1111/j.1540-8159.2010.02781.x.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15: 1280-6. https://doi.org/10.1093/europace/eut029.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15: 1280-6. https://doi.org/10.1093/europace/eut029.Свинцова ЛИ, Ковалёв ИА, Криволапов СН, и др. Клинические и гемодинамические закономерности течения аритмий у детей в возрасте от 0 до 7 лет. Российский кардиологический журнал. 2014;19(12): 31-37. https://doi.org/10.15829/1560-4071-2014-12-31-37.Svintsova LI, Kovalev IA, Krivolapov SN, et al. Clinical and hemodynamic patterns of arrhythmias in children aged 0 to 7 years. Rus J Card. 2014;19(12): 31-37. (In Russ). https://doi.org/10.15829/1560-4071-2014-12-31-37.Epstein AE, Dimarco JP, Ellenbogen KA, et al. ACC/ AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51: e1-62. https://doi.org/10.1016/j.hrthm.2008.04.014.Epstein AE, Dimarco JP, Ellenbogen KA, et al. ACC/ AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51: e1-62. https://doi.org/10.1016/j.hrthm.2008.04.014.Vardas PE, Auricchio A, Blanc JJ, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Europace. 2007;9: 959-98. https://doi.org/10.1093/europace/eum189.Vardas PE, Auricchio A, Blanc JJ, et al. Guidelines for cardiac pacing and cardiac resynchronization therapy. The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in collaboration with the European Heart Rhythm Association. Europace. 2007;9: 959-98. https://doi.org/10.1093/europace/eum189.Brugada J, Blom N, Sarquella-Brugada G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15:1337-82. https://doi.org/10.1093/europace/eut082.Brugada J, Blom N, Sarquella-Brugada G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15:1337-82. https://doi.org/10.1093/europace/eut082.Konta L, Chubb MH, Bostock J, et al. Twenty-Seven Years’ Experience With Transvenous Pacemaker Implantation in Children Weighing˂ 10kg Circ Arrhythm Electrophysiol. 2016;9: e003422. https://doi.org/10.1161/CIR-CEP.115.003422.Konta L, Chubb MH, Bostock J, et al. Twenty-Seven Years’ Experience With Transvenous Pacemaker Implantation in Children Weighing˂ 10kg Circ Arrhythm Electrophysiol. 2016;9: e003422. https://doi.org/10.1161/CIR-CEP.115.003422.Pakarinen S, Oikarinen L, Toivonen L. Short-term implantation-related complications of cardiac rhythm management device therapy: a retrospective single centre 1-year survey. Europace. 2010;12: 103-8. https://doi.org/10.1093/europace/eup361.Pakarinen S, Oikarinen L, Toivonen L. Short-term implantation-related complications of cardiac rhythm management device therapy: a retrospective single centre 1-year survey. Europace. 2010;12: 103-8. https://doi.org/10.1093/europace/eup361.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15(9): 1280-6. https://doi.org/10.1093/europace/eut029.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15(9): 1280-6. https://doi.org/10.1093/europace/eut029.Celiker A, Baspinar O, Karagöz T.. Transvenous cardiac pacing in children: problems and complications during follow-up. Anadolu Kardiyol Derg. 2007;(3):292-7.Celiker A, Baspinar O, Karagöz T.. Transvenous cardiac pacing in children: problems and complications during follow-up. Anadolu Kardiyol Derg. 2007;(3):292-7.Campos-Quintero A, García-Montes JA, Cruz-Arias R, et al. Endocardial Pacing in Infants and Young Children Weighing Less Than 10 Kilograms. Rev Esp Cardiol. (Engl Ed). 2018 Jan;71(1):48-51. https://doi.org/10.1016/j.rec.2017.02.036.Campos-Quintero A, García-Montes JA, Cruz-Arias R, et al. Endocardial Pacing in Infants and Young Children Weighing Less Than 10 Kilograms. Rev Esp Cardiol. (Engl Ed). 2018 Jan;71(1):48-51. https://doi.org/10.1016/j.rec.2017.02.036.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15: 280-1286. https://doi.org/10.1093/europace/eut029.Silvetti MS, Drago F, Di Carlo D, et al. Cardiac pacing in paediatric patients with congenital heart defects: transvenous or epicardial? Europace. 2013;15: 280-1286. https://doi.org/10.1093/europace/eut029.Mah DY, Prakash A, Porras D, et al. Coronary artery compression from epicardial leads: More common than we think. Heart Rhythm. 2018;1-9. doi.org/10.1016/j.hrthm.2018.06.038.Mah DY, Prakash A, Porras D, et al. Coronary artery compression from epicardial leads: More common than we think. Heart Rhythm. 2018;1-9. doi.org/10.1016/j.hrthm.2018.06.038.Carreras EM, Duncan WJ, Djurdjev O, et al. Cardiac strangulation following epicardial pacemaker implantation: a rare pediatric complication. J. Thorac. Cardiovasc. Surg. 2015; 149: 522-527 https://doi.org/10.1016/j.jtcvs.2014.10.094.Carreras EM, Duncan WJ, Djurdjev O, et al. Cardiac strangulation following epicardial pacemaker implantation: a rare pediatric complication. J. Thorac. Cardiovasc. Surg. 2015; 149: 522-527 https://doi.org/10.1016/j.jtcvs.2014.10.094.Takeuchi D, Tomizawa Y. Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment, and prevention. Gen Thorac. Cardiovasc Surg. 2015; 63: 22-29. https://doi.org/10.1007/s11748-014-0483-x.Takeuchi D, Tomizawa Y. Cardiac strangulation from epicardial pacemaker leads: diagnosis, treatment, and prevention. Gen Thorac. Cardiovasc Surg. 2015; 63: 22-29. https://doi.org/10.1007/s11748-014-0483-x.Chihiro M, Yoshie O, Yusuke A, et al. A case of cardiac strangulation following epicardial pacemaker implantation. General Thoracic and Cardiovascular Surgery. 2020; 68: 1499-1502.Chihiro M, Yoshie O, Yusuke A, et al. A case of cardiac strangulation following epicardial pacemaker implantation. General Thoracic and Cardiovascular Surgery. 2020; 68: 1499-1502.Janík M, Hejna P, Straka L, et al. Strangulation of the heart presenting as sudden cardiac death: A deadly but forgotten complication of epicardial pacing device. Legal Medicine, 32 (2018); 107-112 https://doi.org/10.1016/j.legalmed.2018.04.001.Janík M, Hejna P, Straka L, et al. Strangulation of the heart presenting as sudden cardiac death: A deadly but forgotten complication of epicardial pacing device. Legal Medicine, 32 (2018); 107-112 https://doi.org/10.1016/j.legalmed.2018.04.001.Плотникова ИВ, Свинцова ЛИ, Джаффарова ОЮ, и др. Странгуляция левого желудочка у 4-летнего ребенка после эпикардиальной стимуляции. Педиатрия журнал им. Г.Н.Сперанского.2018;97(3): 98-102.Plotnikova IV, Svintsova LI, Dzhaffarova OYu, et al. Left ventricular strangulation in a 4-year-old child after epicardial pacing. Pediatria. 2018;97(3): 98-102.(In Russ).Baruteau A-E, Pass RH, Thambo J-B, et al. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr. 2016;175(9): 1235-1248. https://doi.org/10.1007/s00431-016-2748-0.Baruteau A-E, Pass RH, Thambo J-B, et al. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr. 2016;175(9): 1235-1248. https://doi.org/10.1007/s00431-016-2748-0.Lyon S, Dandamudi, Kean AC. Permanent his-bundle pacing in pediatrics and congenital heart disease. J Innov Cardiac Rhythm Manage. 2020;11(2): 4005-4012. https://doi.org/10.19102/icrm.2020.110205.Lyon S, Dandamudi, Kean AC. Permanent his-bundle pacing in pediatrics and congenital heart disease. J Innov Cardiac Rhythm Manage. 2020;11(2): 4005-4012. https://doi.org/10.19102/icrm.2020.110205.Janousek J, Kubus P. What’s new in cardiac pacing in children? Curr Opin Cardiol. 2014; 29:76-82. https://doi.org/10.1097/HCO.0000000000000025.Janousek J, Kubus P. What’s new in cardiac pacing in children? Curr Opin Cardiol. 2014; 29:76-82. https://doi.org/10.1097/HCO.0000000000000025.Song MK, Kim NY, Bae EJ, et al. Long-term Follow-up of Epicardial Pacing and Left Ventricular Dysfunction in Children With Congenital Heart Block. Thorac Surg. 2020;109(6): 1913-1920. https://doi.org/10.1016/j.athoracsur.Song MK, Kim NY, Bae EJ, et al. Long-term Follow-up of Epicardial Pacing and Left Ventricular Dysfunction in Children With Congenital Heart Block. Thorac Surg. 2020;109(6): 1913-1920. https://doi.org/10.1016/j.athoracsur.Kovanda J, Lousek M, Ono S, et al. Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function. Europace. 2020;22: 306-313. https://doi.org/10.1093/europace/euz325.Kovanda J, Lousek M, Ono S, et al. Left ventricular apical pacing in children: feasibility and long-term effect on ventricular function. Europace. 2020;22: 306-313. https://doi.org/10.1093/europace/euz325.Dodge-Khatamia A, Kadnera A, Davea H, et al. Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approachwith excellent functional and cosmetic result. European Journal of Cardio-thoracic Surgery. 2005;4: 541-545. https://doi.org/10.1016/j.ejcts.2005.06.040.Dodge-Khatamia A, Kadnera A, Davea H, et al. Left heart atrial and ventricular epicardial pacing through a left lateral thoracotomy in children: a safe approachwith excellent functional and cosmetic result. European Journal of Cardio-thoracic Surgery. 2005;4: 541-545. https://doi.org/10.1016/j.ejcts.2005.06.040.Fender EA, Killu AM, Cannon BC, et al. Lead extraction outcomes in patients with congenital heart disease. Europace. 2017;19(3): 441-446. https://doi.org/10.1093/europace/euw049.Fender EA, Killu AM, Cannon BC, et al. Lead extraction outcomes in patients with congenital heart disease. Europace. 2017;19(3): 441-446. https://doi.org/10.1093/europace/euw049.McCanta AC, Schaffer MS, Collins KK. Pediatric and Adult Congenital Endocardial Lead Extraction or Abandonment Decision (PACELEAD) survey of lead management. Pacing Clin Electrophysiol. 2011;34: 1621-1627.McCanta AC, Schaffer MS, Collins KK. Pediatric and Adult Congenital Endocardial Lead Extraction or Abandonment Decision (PACELEAD) survey of lead management. Pacing Clin Electrophysiol. 2011;34: 1621-1627.Zareba W, Klein H, Cygankiewicz I, et al. MADIT-CRT Investigators. Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011;123: 1061-1072. https://doi.org/10.1161/CIRCULATIONAHA.110.960898.Zareba W, Klein H, Cygankiewicz I, et al. MADIT-CRT Investigators. Effectiveness of Cardiac Resynchronization Therapy by QRS Morphology in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). Circulation. 2011;123: 1061-1072. https://doi.org/10.1161/CIRCULATIONAHA.110.960898.

The authors declare that there are no conflicts of interest present.