SUMMARY Twenty-four patients in the pediatric age range who underwent implantation of a cardiac pacemaker for treatment of complete atrioventricular (A-V) block were followed for: an average of five years (range 1-12 years). The etiology of the A-V block was surgical in 13 cases, congenital in nine, and acquired in two. Twenty patients had symptoms of cerebrovascular insufficiency and four had congestive heart failure. To date, 18 of the 24 patients studied are REMARKABLE PROGRESS has been made in the management of patients with complete atrioventricular (A-V) block by artificial cardiac pacing. After the experimental work of Callaghan and Bigelow' in 1951 and the first clinical application by Zoll' in 1952, Weirich et al.3 applied direct myocardial stimulation in patients with surgically induced heart block. Subsequent improvements in pacemakers have been contributed by Glenn,4 Chardack,5 Zoll,8 and Kantrowitz.7 The increasing use of cardiac pacemakers in the treatment of patients with complete A-V block is the result of several factors: 1) improved and simplified techniques of both temporary and permanent pacing;8 2) advances in technology leading to more dependable electrodes and generators;9 3) increasing clinical experience and follow-up data indicating a favorable effect on prognosis; and 4) better cardiovascular performance in patients with A-V block treated with pacemakers rather than with chronotropic agents.'0 Despite the extensive use of pacemakers in adults, experience with children is small. Seven series reported in the literature have listed the indications for, and short-term follow-up of pacemakers in children.'",' A review of our 12 years experience (average follow-up, five years; range, 1-12 years) with implantation of cardiac pacemakers in 24 children is presented. Luke's Episcopal Hospital, and Texas Heart Institute. There were 14 males and ten females. Indications for pacemaker implantation included symptoms of cerebrovascular insufficiency ranging from dizziness to syncope and convulsions in 20 patients, and signs and symptoms of congestive heart failure in four patients.
Materials and MethodsThirteen patients had complete A-V block as a complication of surgical repair of a congenital heart defect (table 1). Nine patients had congenital complete A-V block (table 2) and in four of them this was an associated congenital cardiac defect. Complete A-V block was "acquired" spontaneously in two patients. One of these had onset of A-V block at age nine years associated with Refsum's disease'7 (chronic polyneuropathy associated with ichthyosis, deafness, and retinitis pigmentosa secondary to lipoid storage). Atrioventricular block had occurred in another patient at 20 years of age during her second trimester of pregnancy.The resting ventricular rate in the 24 patients ranged from 31 to 85, average 46 beats/min. The QRS duration and morphology was normal in seven patients; 11 had left bundle branch block and six had right bundle branch block. Four patients exhibited an unstable cardiac pacemaker, ...