Avtor/Urednik		Kosin, Miro
Naslov		Srčni spodbujevalniki pri dojenčkih in otrocih
Prevedeni naslov		The use of pacemarkers in infants and children
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 74, št. Suppl 1
Leto izdaje		2005
Obseg		str. I-49-58
Jezik		slo
Abstrakt		Background. To review retrospectively our experience with pediatric cardiac pacing with an emphasis on specific problems in pacemaker implantation in infants and children. Methods. Between April 1977 and March 2005 ninety-one child underwent permanent pacemaker implantation, 46 boys (50.5%) and 45 girls (49. 5) with a mean age of 7.9 years (the oldest 17 years and the youngest 1 day). The age of the children at the time of implantation was 2 to 9 years in one half and 14 to 17 years in one fourth of them. Five children were younger than one month and three of them younger than one week. The indications for permanent pacing were complete atrioventricular block (CAVB) in more than half patients, sick sinus syndrome in one fourth and CAVB following open heart surgery in nine. The mean time for elective battery replacement was 6.5 years after the implantation. In one third of the children the battery was replaced before the end of the fifth year after the implantation and after seven years in more than half of the patients. Epicardial leads and left anterior thoracotomy or subxyphoid approach were used at the beginning. From the year 1980 we prefered transvenous leads. Modern epicardial steroid-eluting leads demonstrated relatively stable acute and chronic pacing and sensing tresholds. WI/R pacemaker was the, pacemaker of choice at the first implantation and we upgraded the pacing at the time of the elective battery replacement. Children with VDD pacemakers needed sometimes upgrading of pacing sooner because of the inappropriaate atrial sensing and AV synchronyzation. Conclusions. Better quality pacing leads and smaller but more powerful pacemaker generators with autocapture-controlled pacing options became more and more attractive for our little patients because of better impluntation facilities, substantial energy savings and battery life prolongation.
Izvleček		Metode. Od aprila 1977 do marca 2005 smo stalni srčni spodbujevalnik vstavili 91 otrokom, 46 dečkom (50,5%) in 45 deklicam (49,5%). Povprečna starost otrok ob vstavitvi stalnega srčnega spodbujevalnika je bila 7,9 leta (najstarejši 17 let in najmlajši 1 dan). Polovica otrok je bila pri operaciji stara 2 do 9 let, četrtina od 14 do 17 let, 5 manj kot 1 mesec in od teh trije manj kot teden dni. Prirojeni popolni predvornoprekatni blok je bil razlog za vstavitev stalnega srčnega spodbujevalnika pri več kot polovici operiranih otrok, bolezen sinusnega vozla pri četrtini, popolni preddvornoprekatni blok po operaciji na odprtem srcu pa pri devetih otrocih. Baterijo smo morali zaradi izrabljenosti zamenjati povprečno 6,5 leta po vstavitvi (najprej po 1 letu in najpozneje po 12 letih). Pri tretjini otrok smo morali izrabljeno baterijo zamenjati pred koncem petega leta po vstavitvi, pri več kot polovici otrok pa šele po sedmih letih. Do leta 1980 smo uporabljali miokardne elektrode ter sprednjo levo torakotomijo in subksifoidni pristop, kasneje praviloma endokavitarne, epikardialne pa samo v posebnih primerih. Novejše epikardialne elektrode, prevlečene s steroidom, imajo vse boljše lastnosti v smislu nižjega kroničnega praga vzdražnosti in boljšega zaznavanja. Prvi spodbujevalnik je bil praviloma VVI/R, ob izrabi baterije pa smo elektrostimulacijo nadgradili. Tistim z VDD spodbujevalnikom smo morali včasih zaradi slabega zaznavanja v preddvorih elektrostimulacijo predčasno nadgraditi v DDD način. (Izvleček skrajšan na 2000 znakov)
Deskriptorji		HEART DEFECTS, CONGENITAL CARDIAC PACING, ARTIFICIAL HEART BLOCK INFANT CHILD TREATMENT OUTCOME