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首页> 外文期刊>Archives of cardiovascular diseases. Supplements >Pacing in the paediatric population:indications, implantation strategies,evolution and new stimulation techniques
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Pacing in the paediatric population:indications, implantation strategies,evolution and new stimulation techniques

机译：儿科人群的起搏：适应症，植入策略，演变和新的刺激技术

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Although the general indications for pacemaker implantation in children and adolescents are similar to those in adults, there are several important considerations in young patients. Congenital atrioventricular block, surgical or acquired atrioventricular block, sinus node dysfunction, bradycardia - tachycardia syndrome, long QT syndrome and cardiac resynchronization therapy are the main indications for pacing in the paediatric population. One of the peculiar characteristics in young patients is the long duration of pacing, which involves: difficult reflection regarding the indications for and timing of pacing therapy (all the more so given that the absence of randomized clinical trials of cardiac pacing conducted in the paediatric population, which means that the level of evidence for most recommendations is based on consensus); and the choice between endocardial and epicardial approaches. Indeed, children can now undergo implantation of epicardial or endocardial pacing systems with low rates of short- and mid-term complications. However, despite no clear demonstration in the literature because of the absence of studies with life-long follow-up, long-term complications may impact on the life expectancy of these patients. Lifelong pacing effects on a suboptimal or detrimental ventricular site may have been underestimated. Moreover, children are prone to a higher incidence of long-term adverse events because of the pacing device. In this review, we present the pacing indications and recommendations in the paediatric population, we discuss the benefits and limitations of epicardial and endocardial approaches and we examine whether new cardiac stimulation techniques might enable an absolute revolution in pacing therapy.
机译：尽管在儿童和青少年中植入起搏器的一般适应症与成人相似，但在年轻患者中有一些重要的考虑因素。先天性房室传导阻滞，手术或获得性房室传导阻滞，窦房结功能障碍，心动过缓-心动过速综合征，长QT综合征和心脏再同步治疗是小儿起搏的主要适应症。年轻患者的特殊特征之一是起搏时间长，这涉及：对起搏治疗的适应症和时机难以反思（鉴于缺乏在儿科人群中进行心脏起搏的随机临床试验，这一点尤其如此） ，这意味着大多数建议的证据水平基于共识）;以及心内膜​​和心外膜方法之间的选择。实际上，儿童现在可以接受心外膜或心内膜起搏系统的植入，短期和中期并发症的发生率较低。然而，尽管由于没有进行终生随访的研究而在文献中没有明确的论据，但长期并发症可能会影响这些患者的预期寿命。对次优或有害心室部位的终生起搏作用可能被低估了。此外，由于起搏装置的缘故，儿童容易发生长期不良事件。在这篇综述中，我们介绍了小儿人群的起搏适应症和建议，我们讨论了心外膜和心内膜入路的好处和局限性，并且我们研究了新的心脏刺激技术是否可能使起搏治疗发生绝对的革命。

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