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- Wed Dec 31, 2008 3:08 am
I am asking this for a kid
Sex : Male Age : 2 years
He has undergone surgery for TOF . After that he is facing some problems with heart rate. Current demographics report shows following observations when captured for 24 hours.
Local Doctor is advicing for Pacemaker ......Please advice if that is the only solution available or any other medication is also solution for same ? .....If pacemaker is only solution then which pacemaker type should be used in this case.
Observations for 24 hours measurements are as follows :
The average Heart rate was 70 BPM . The minimum heart rate was 57 BPM . The maximum heart rate was 97 BPM.
Ventricular ectopic activity consisted of 16 beats of which 12 were in single PVCs 2 were in interpolated PVCs, 2 were in R on T.
The patient's rhythm included 1 hr 32 min 28 sec of bradycardia. the slowest single episode of bradycardia occurred at 10:07:27 PM , lasting 1 min 23 sec , with minimum heart rate of 57 BPM.
Supraventricular ectopic activity consisted of 25 beats , of which 25 were single PACs. The longest R-R interval was 1.2 seconds . The longest N-N interval was 1.2 seconds .
Some interpretation from report :
1) Baseline Rhythm is complete heart block with intermittent paced rhythm.
2) Heart rate variability is normal.
3) Occasional ventricular ectopics seen.No episode of NSVT /VT recorded.
4) Occasional supraventricular ectopics seen
5) No significant pauses or brady events.
6) No significant ST T changes seen in channel 2 & channel 3
| John Kenyon, CNA
- Wed Dec 31, 2008 12:57 pm
While complete heart block will rarely correct itself (usually it means there is some damageto, or failure to fully develop some part of the heart's electrical system) and therefore a pacemaker is almost always required; and since the rate was uniformly slow for a child of the age of two heart block would seem convincing; the fact that the rate varied over 24 hours some 40 beats per minute. In complete heart block the rate is determined by the ventricles at a slow, fixed, "escape" rate and rhythm that doesn't vary by much. The average rate was 70, which, again, is slow for a child of this age, and suggestive of some sort of block, but the variation is so great that complete heart block is clearly intermittent (or as the report states, is "intermittently paced"). While this is not a status of complete heart block, it is likely to progress to that point, and even if it remains intermittent, as the child grows and the rate slows, this will become, even if intermittent, a great problem which will interfere with function and could lead to life-threatening problems in adulthood (or earlier). A demand pacemaker programmable to full-time pacing if needed would seem the best solution. While this probably seems extreme in such a small child, as he grows he will "grow into" his pacemaker, and by adolescence, when he is totally used to its presence anyway, it will seem much smaller and far less cumbersome and intrusive than it will during early childhood. But mainly, it will allow him a relatively normal life and activities.
Given the facts as reported by the cardiology technician and signed off by the doctor, I would say yes, definitely this is a case where a pacemaker would be not only necessary but perhaps even life-saving over the long term. The only (minor) annoyance, beyond early childhood adaptation to the pacer's presence, would be the occasional office visits for pacer checking and the battery replacements, every few years (which, over time, will probably become less frequent).
I hope this is helpful to you. Best of luck, and please follow up with us as needed.