ABSTRACT
AIMS: To evaluate pacing system survival and complications to pacemaker (PM) therapy in children with isolated complete atrioventricular block (CAVB). METHODS AND RESULTS: We performed a nationwide retrospective study of children diagnosed before 15 years of age with isolated CAVB and PM treatment. Between 1983 and 2012, 127 patients underwent PM-implantations at 3.2 (0-17) [median (range)] years and were followed for 11 (0.6-19) years. An endocardial or epicardial PM system was implanted in 72 and 55 patients, respectively. A total of 306 pacing leads (76% steroid-eluting) were implanted. Pacing system survival was significantly affected by age, with a higher risk of a new intervention for children aged <1 month at first implantation. Lead survival of the steroid-eluting leads at 5 and 10 years was 90 and 81%, respectively, with no difference between epicardial and endocardial systems. Complications leading to revision of the pacing system occurred in 24% of the patients. Patients aged <1 month at first PM implantation had a five-fold increased risk for a complication to occur. Dividing the cohort according to year of first procedure showed that those who had their first implantation ≥2002 had fewer complications and also lead- and pacing system survival was better in the later cohort. CONCLUSION: Pacing system survival and complications to PM therapy in young patients with isolated CAVB were significantly affected by age, with low age at PM implantation constituting a risk factor. Endocardial and epicardial pacing systems showed no significant differences in performance.
Subject(s)
Atrioventricular Block/therapy , Forecasting , Pacemaker, Artificial/adverse effects , Risk Assessment/methods , Adolescent , Atrioventricular Block/mortality , Child , Child, Preschool , Equipment Failure , Follow-Up Studies , Humans , Infant , Infant, Newborn , Retrospective Studies , Risk Factors , Survival Rate/trends , Sweden/epidemiology , Treatment OutcomeABSTRACT
OBJECTIVES: Congenital heart block (CHB) occurs in 1%-2% of anti-Ro/SSA antibody-positive pregnancies. A population-based recurrence rate of 12% indicates that factors other than maternal autoantibodies influence CHB development. Here we report the first investigation to identify environmental and lifestyle factors influencing the risk of CHB. METHODS: A questionnaire focused on environmental and lifestyle factors was distributed to anti-Ro/SSA antibody-positive women who had given birth to at least one child with CHB, and additional data were retrieved from national health registers. Statistical analysis was performed comparing pregnancies resulting in a child with CHB (n=81) and pregnancies resulting in unaffected siblings (n=108). RESULTS: Analysis of maternal body mass index and weight gain during pregnancy as well as medication intake and sun exposure did not reveal significant differences between CHB-affected and non-CHB pregnancies. By contrast, we found that reports of infections and stressful events were significantly more frequent in CHB-affected pregnancies than in non-CHB affected pregnancies (OR 17.9, 95% CI 4.1 to 162.8, p<0.001 and OR 5.5, 95% CI 1.1 to 55.1, p<0.05, respectively). Notably, outdoor activity a few hours per day emerged as a protective factor (OR 0.52, 95% CI 0.27 to 0.99, p<0.05). The previously reported factor seasonal timing of pregnancy was confirmed (OR 2.2, 95% CI 1.1 to 4.2, p<0.05), and multivariate analysis revealed that this association was partly explained by infection and outdoor activity. CONCLUSIONS: In this retrospective study, infections, stressful events and time spent with outdoor activities emerged as potential environmental and lifestyle factors influencing the risk of CHB, warranting confirmation in prospective studies.