Opportunities of physiological PMs programming in children for noninvasive correction of pacing and/or sensing infringements

Abstract

Aim: The aim of the study was evaluation of the efficacy of prophylactic use of a single dose of a beta-lactamase antibiotic and aminoglycosideadministered locally and/or systemically during cardiac pacemaker insertion procedures. Materials and methods: The analysis was carried out over a period from 30.04.1992 to 30.06.2000. A total of 2215 procedures were carried out on 1072 women and 1143 men aged between 18 and 101 years (mean age 72,5 years). The following pacemakers were implanted: AAI/AAIR-122. WINVIR-1440, VDDNDDR-50, DDD/DDDR-293, BiA-4, BW-2, pacemakers were replaced in 264 patients (pts). Each procedure was preceded by intravenous administration of an antibiotic: beta-lactamasecephalospodn and aminoglycoside. Closure of the cavity was preceded by locally "washing it out" with the cephalosporin previously administered intravenously. Further administration of the antibiotic depended on the presence of risk of infection factors. These were assumed to be: temporary transvenous cardiac pacing, extended duration of procedure (50-60 min.), immunological disorders, diabetes, infectious foci not eliminated prior to the operation. The "standard" procedure -a single dose of antibiotic prior to the surgical procedure and topical administration -was performed in 1649 pts (74%). This method made it possible to avoid complications in the form of infection, during the 9-year observation pedod of the group of pts without risk factors, in 100% of cases. In 6 out of 566 pts (1,1%) with at least one risk of infection factor, inflammation developed above the course of the electrode. In all pts this complication was controlled by conservative therapy without necessitating removal of the system. Conclusions: The prophylactic antibiotic therapy scheme (single intravenous dose combined with local lavage of the pacemaker cavity) used in permanent cardiac pacing procedures enabled elimination of infectious complications in the group of pts without risk factors. We have a general experience of 152 PM implantation in children. We analyzed 70 children with physiological PMs implanted since 1994. The average age on the moment of PM implantation is 9,6.+3,8 years (from 2 years 2 months till 15 years 9 months). Average follow-up period is 50,2.+28,7 months (1-70 months). All the children were divided into 3 groups depending of aetiology: 1 -congenital conducting system defects (N=23), 2 -myocarditis in history (N=15), 3 -surgically corrected congenital heart defects (N=14). Results: the significant difference between 1 and 2 groups is revealed on chronic atrial (2,5.+1,9 V vs 1,7_+0,7 V) and ventdcular (1,7+0,7 V vs 1,3_+0,4 V) pacing thresholds; between 2 and 3 groups -on atrial pacing thresholds (1,7.+0,7 V vs 2,7.+1,4 V); between 1 and 3 groups -on ventricular pacing thresholds (1,7.+0,7 V vs 1,1.+0,4 V). Conclusion: Thus, in children with congenital conductivity disturbances with absence of any heart pathology higher atrial and ventricular pacing thresholds were observed in comparison with children having postmyocarditis cardiosc...