Análise dos fatores de risco para mortalidade na estimulação pediátrica endocárdica transfemoral: experiência em longo prazo

Abstract

Objective: Permanent cardiac pacing improves survival of children with congenital or acquired bradycardia, although mortality after pacing remains relatively high. The aim of this study was to evaluate the long-term outcomes of children who undergo permanent endocardial pacing via the femoral vein, including the identification of associated risk factors for mortality.Method: From 1981 to 2000, 99 patients ranging in ages from one day to 13 years (4.1 ± ± ± ± ± 3.6 and median = 3 years) underwent permanent transfemoral pacemaker implantation due to congenital (39.4%), post-surgical (54.5%), or nonsurgically acquired bradycardia (6.1%).Results: By the end of 7.1 ± 5.3 years (708.3 patient-years) of prospective follow-up, 18 (18.2%) patients had died. The actuarial survival rates were 85%, 79.5%, and 74.2%, at 5, 10, and 15 years, respectively. Independent predictors of mortality identified by Cox proportional hazards analysis were younger age at implantation (p = 0.028), the presence of untreated cardiac anomalies or intracardiac prostheses (p = 0.0001), and radiographic evidence of cardiomegaly (p = 0.035). Conclusions: Permanent endocardial pacing via the femoral vein presented survival expectance comparable to other techniques with a low rate of pacing complications. Long-term survival was limited by lower ages and cardiac dilatation at the time of implantation as well as by the presence of untreated cardiac defects or valve prostheses.Descriptors: Cardiac pacing, artificial. Pediatrics. Heart block, mortality. Risk factors. Análise dos fatores de risco para mortalidade na estimulação pediátrica endocárdica transfemoral: experiência em longo prazoRisk factors analysis in transvenous pediatric pacing through femoral access: long-term experience 124 COSTA, R ET AL -Risk factors analysis in transvenous pediatric pacing through femoral access: long-term experience Braz J Cardiovasc Surg 2005; 20(2): 123-128