Experience of treating congenital complete atrioventricular block with epicardial pacemaker in infants and young children:a retrospective study

Background: This article summarizes the treatment experience for congenital complete atrioventricular block (CCHB) in newborns and infants, and discusses the necessity and feasibility of treating CCHB with permanent pacemaker implantation in this population. Methods: In this study, the clinical data and follow-up results of nine children admitted at our center with CCHB from January 2005 to March 2023 were retrospectively analyzed. Among them, two children received early implantation of permanent pacemakers (within 1 year of age), two children received non-early implantation (1 year or older), and the remaining five children received no pacemaker implantation. CCHB diagnosis was confirmed by clinical symptoms and clinical examinations, including electrocardiography and echocardiography before surgery. After surgery, the pacing and sensing functions of the pacemaker were observed using electrocardiography, echocardiography, and pacing threshold monitoring. A comprehensive evaluation of the treatment effect was performed, taking into account improvements in clinical symptoms, growth and development, and the absence of any other potential complications. The children who did not receive pacemaker implantation were followed up. Results: Among the four children who successfully received pacemaker implantation, one child who received non-early implantation died. For the remaining three children, the threshold level, amplitude, impedance, and minute ventilation sensor function of the pacemaker were good during the follow-up period, with a heart rate at the pacing rate. Their development followed the percentile curve, and their motor and cognitive development were not affected. Among the children who did not receive pacemaker implantation, two died and three were lost to follow-up. Conclusions: Early implantation of an epicardial pacemaker in newborns and infants diagnosed with CCHB can significantly improve clinical symptoms without affecting their growth and development. In this study, we have determined that permanent pacemaker implantation is necessary for these children because the treatment plan's safety, feasibility, and favorable prognosis.