HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Carl L. Backer Robert D. Stewart Constantine Mavroudis Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kelle, A. M. Articles by Mavroudis, C. Search for Related Content PubMed Articles by Kelle, A. M. Articles by Mavroudis, C. Related Collections Congenital - cyanotic Electrophysiology - arrhythmias

J Thorac Cardiovasc Surg 2007;134:1188-1192
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Dual-chamber epicardial pacing in neonates with congenital heart block

^a Division of Cardiovascular and Thoracic Surgery, Children’s Memorial Hospital, Chicago, Ill
^b Division of Cardiology, Children’s Memorial Hospital, Chicago, Ill
^c Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
^d Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.

Received for publication March 2, 2007; revisions received April 5, 2007; accepted for publication April 16, 2007.

^_* Address for reprints: Carl L. Backer, MD, Division of Cardiovascular-Thoracic Surgery, M/C #22, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614. (Email: cbacker{at}childrensmemorial.org).

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.

This article has been cited by other articles:

				A. C. Glatz, J. W. Gaynor, L. A. Rhodes, J. Rychik, R. E. Tanel, V. L. Vetter, J. R. Kaltman, S. C. Nicolson, L. Montenegro, and M. J. Shah Outcome of high-risk neonates with congenital complete heart block paced in the first 24 hours after birth J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 767 - 773. [Abstract] [Full Text] [PDF]