Long-term results of endocardial pacing with Autocapture™ threshold tracking pacemakers in children

PubMedID: 16216759Aim: We aimed to evaluate the long-term results of endocardial pacing with Autocapture™ threshold tracking pacemakers in children. Methods and results: Implantation and follow-up data of 20 children with these pacemakers were retrospectively evaluated. The pacemakers were implanted subpectorally in five and subcutaneously in 15 patients. The indication for pacing was high-grade atrioventricular block in 18 cases. The mean age at implantation was 7 ± 4.8 years. Four patients were pacemaker dependant (heart rate < 30 bpm). At implantation, the mean pacing threshold was 0.5 V at 0.5 ms. The mean evoked response (ER) signal was 8.5 ± 3.6 mV, and the polarisation signal (PS) was <1 mV in 15 patients and 1-2 mV in five patients. During the mean follow-up period of 60 months, mean ER signal decreased significantly to 7.7 ± 6.3 mV at 24 months and 6.5 ± 2.5 mV at 60 months (P < 0.05). In four of 15 patients (26.6%), with a predischarge PS value of <1 mV, it increased between 1 and 2 mV over time. During follow-up, autocapture function was deactivated in six (30%) patients; due to inappropriate ER/PS values in four and due to severe muscle twitching in two with subpectoral implants. These problems occurred during a median period of 21 months after implantation. Generators were replaced in three patients with Microny pacemakers because of battery depletion at 54, 66 and 78 months. In two of them autocapture function had been working since implantation. In seven of 10 patients, who completed ?60 months of follow-up, battery impedances were still at the predischarge level. Conclusions: Autocapture function works well in most children at implantation. Mean ER signal significantly decreases over time despite stable pacing parameters. Autocapture function may become nonoperational due to decreased ER signal in some patients. Muscle twitching may be an important problem that may result in discontinuation of autocapture function in children with subpectoral implants. © 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved

Long-term results of endocardial pacing with Autocapture (TM) threshold tracking pacemakers in children

WOS: 000233324000010PubMed ID: 16216759Aim We aimed to evaluate the Long-term results of endocardial pacing with Autocapture (TM) threshold tracking pacemakers in children. Methods and results Implantation and follow-up data of 20 children with these pacemakers were retrospectively evaluated. The pacemakers were implanted subpectorally in five and subcutaneously in 15 patients. The indication for pacing was high-grade atrioventricutar block in 18 cases. The mean age at implantation was 7 +/- 4.8 years. Four patients were pacemaker dependant (heart rate = 60 months of follow-up, battery impedances were still at the predischarge level. Conclusions Autocapture function works well in most children at implantation. Mean ER signal significantly decreases over time despite stable pacing parameters. Autocapture function may become nonoperational due to decreased ER signal in some patients. Muscle twitching may be an important problem that may result in discontinuation of autocapture function in children with subpectoral implants. (c) 2005 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved

Cardiac multidetector computed tomography (MDCT) of spontaneously closed ventricular septal defect

WOS: 000266092200003PubMed ID: 19444383The authors present the findings of contrastenhanced electrocardiogram (ECG)-gated cardiac computed tomography (CT) in 18 patients with probably spontaneous closure of muscular ventricular septal defect (VSD). The study included 2,725 consecutive patients referred to our hospitals for multidetector computed tomography (MDCT) coronary angiography. The patients were between the ages of 5 and 78 [mean +/- standard deviation (SD) 59 +/- 13.86] years, and 1,816 (66.6%) were male. Evaluating the images for coronary artery pathologies revealed pouches or sacs in the central muscular location of the septa of some patients. All patient records were retrospectively reviewed, and 18 patients were found to have pouches or sacs in the interventricular septum location likely to be spontaneous closure of muscular VSD (0.66% prevalence). MDCT findings of these 18 patients correlated with their echocardiographic findings. Of the patients with muscular VSD, 13 were male and five were female. These 18 patients were initially referred due to indications such as chest pain (n=11), risk-factor assessment (n=3), coronary artery anomaly (n=1), suspected aberrant right subclavian artery due to dysphagia (n=1) and coronary artery bypass graft (n=2). Our study shows that the incidence of spontaneous closure of muscular VSD with central septum location is probably higher than expected. Thus, some patients initially diagnosed with ventricular diverticula with an apical and marginal septum location may actually have spontaneously closed muscular VSD. This finding may affect previously reported rates of both ventricular diverticula and spontaneous closure of muscular VSD