A single institution experience with pacemaker implantation in a pediatric population over 25 years.

BACKGROUND: With the development of new technical devices and software more appropriate for pediatric patients, pacemaker implantations in children and young adults have increased over time. It is necessary to monitor the mid- and long-term consequences. The decision for the implantation of a cardiovertor defibrillator (ICD) in children remains challenging despite technical improvements. OBJECTIVE: To assess the safety of pacemaker implantation in children, to review old and new indications, and to point out changes of management over time. PATIENTS AND METHODS: Between 1984 and 2009, 181 patients required the implantation of a pacemaker or an ICD device at the Heart and Diabetes Centre in Bad Oeynhausen, Germany. Their charts have been reviewed pro- and retrospectively for indications, complications, longevity of the device, and the natural course. RESULTS: Indications have been high-degree atrioventricular block in 65% (postoperative 55%) and sinus node dysfunction in 24% (postoperative 90%), including three patients with vasovagally mediated significant bradycardia. Eleven percent required the implantation of an ICD device secondary to significant ventricular arrhythmias. The indication was class II in one-third of all patients. Complications requiring revision occurred in six patients (3.3%); one of them required removal of the device due to an infection. Ten patients died, but none related to pacemaker implantation. CONCLUSION: Pacemaker implantation even in young pediatric patients is generally safe. No complication led to the death of a patient. The number of class II indications has been increasing. The future aim is to improve pediatric algorithms and to prevent unnecessary pacing.

Infective endocarditis in infancy after complete atrioventricular septal defect repair.

We report a rare case of infective endocarditis after repair of a complete atrioventricular (AV) septal defect in a four-month-old patient. Perforation of a valve leaflet with progressive severe left AV valve regurgitation required surgical intervention. Valve reconstruction using fresh autologous pericardium was successfully accomplished. This reconstruction in association with prolonged antibiotic therapy resulted in complete recovery of the patient.