Permanent cardiac pacemaker in infants and children.

Between October 1970 and November 1984, 26 infants and children aged 11 days to 18 years (mean 5.7 years) received 42 permanent cardiac pacemakers (26 primary implants, 16 re-implants) for congenital or surgically acquired heart block, bradycardia and sinus node dysfunction. Twenty-two patients had unipolar pacing and 4 bipolar pacing. Of 26 primary implantations, 2 had fixed rate epicardial pacing, 16 ventricular demand pacing (13 epicardial, 3 endocardial), 3 epicardial VAT (P-synchronous) pacing and 5 DDD (universal) pacing (4 epicardial, one endocardial). Fourteen patients required a further 19 operations for change of generators (16), ventricular lead (1), generator site (1) and generator encasing (1). Thirty-day hospital mortality was 11.5% (3/26), of which one death was possibly related to pacing failure. Four patients died during the follow-up period (3 months to 10 years; mean 3.4 years). Sixteen of the 19 survivors achieved complete symptomatic relief, without any medical therapy. Our results indicate that modern cardiac pacemaker systems are safe and reliable, and are associated with major relief of symptoms in this age group.

Telephone monitoring of patients with pacemakers in the west of Scotland.

A regional telephone pacemaker follow-up service has been established in the west of Scotland. Medical care is provided by clinics at district general hospitals in Ayrshire, and the pacemaker signals are transmitted by telephone from these clinics to a pacemaker centre in Glasgow. The success of the pilot project in Ayrshire will allow expansion of the service to include hospitals in other areas of the west of Scotland. The scheme is carefully monitored to ensure that patients with pacemakers receive adequate attention with a minimum of inconvenience.

Displacement of pacemaker leads--a 10-year survey.

Displacement of endocardial pacemaker leads from the initial site at the time of implantation is a major cause of unpredictable pacemaker failure. In this survey, we have made a retrospective study of the effectiveness of the attempts made by two manufacturers to design leads to reduce the frequency of this occurrence. The cumulative displacement records of 5 types of leads (Medtronic types 5818, 6904, 6901, and 6950, and Cardiac Pacemakers Inc. type 4210) have been studied, and show that Medtronic 5818 and 6950, and CPI 4210 leads are superior in this respect.