Evolução de crianças com idade inferior a 2 anos submetidas a implante de marcapasso cardíaco permanente

A estimulacao epicardica predomina no implante de marcapasso em criancas pequenas. Objetivo: revisar a evolucao de pacientes menores de dois anos submetidos a estimulacao epimiocardica apos a alta hospitalar e ate uma decada. Metodo: Estudo de coorte historica entre 1997 e 2010 que incluiu 34 pacientes, 22 (64,7%) do sexo feminino e 12 (35,3%) do masculino, com idades variando de 1 dia a 22 meses, submetidos a implante de marcapasso utilizando cabo-eletrodo epimiocardico sem sutura e gerador unicameral (VVI). A arritmia pre dominante foi o bloqueio atrioventricular (n=30; 88,2%); 29 (85,3%) tinham cardiopatia estrutural e 22 (67,4%) haviam sido previamente submetidos a cirurgia cardiaca. Acompanhados durante um tempo medio de 60,5 meses, tiveram registrados os eventos adversos e calculada a probabilidade de sobrevida conforme Kaplan-Meyer. Resultados: Ocorreram tres obitos (8,8%) por infeccao, cirurgia cardiaca ou mal subito. A mortalidade foi superior naqueles sem cirurgia cardiaca previa (16,7% versus 4,5%). Ao longo do acompanhamento, cinco pacientes (14,7%) necessitaram de nova intervencao, dois por infeccao e tres para reimplante de cabo-eletrodo. Um dos pacientes submetidos a nova intervencao por infeccao evoluiu para obito. A probabilidade de sobrevida foi de 93,8% no primeiro ano e 90,3% ate 10o ano. A sobrevida livre de eventos adversos foi de 90,8% no primeiro ano, 79,8% do 5o ao 9o e 66,5% no 10o ano. Conclusao: Os resultados evidenciam sobrevida satisfatoria das criancas apos o implante epicardico, especialmente aquelas com cirurgia cardiaca previa. O implante de cabo-eletrodo epimiocardico merece cuidados adicionais em pacientes com estatura reduzida, malformacoes cardiacas especificas, acesso dificultado a veia cava superior ou com procedimento cirurgico associado...(AU) Objective: Epicardial stimulation remains the technique of choice for pacing in small children. Our objective is to review the results of epicardial pacemaker implantation in patients with less than 2 years of age and after hospital discharge. Methods: Historical cohort study including 34 patients with age ranging from one day to 22 months with hospital discharge after permanent pacemaker implantation with a sutureless epimyocardial electrode and single chamber generator (VVI mode) between 1997 and 2010. Twenty-two patients were female and 12 male. Predominant arrhythmia was atrioventricular block (30 patients; 88.2%). Twenty-nine patients (85.3%) had structural heart disease and 22 (67.4%) had been submitted to a previous heart surgery. Patients were followed-up for a mean time of 60.5 months. Recorded events were analyzed and probability of survival was estimated according to Kaplan-Meyer analysis. Results: There were 3 (8.8%) deaths, due to infection, heart surgery or sudden death. Increased mortality was observed for patients without previous heart surgery (16.7% versus 4.5%). Five patients (14.7%) required pacemaker reintervention during the follow-up, 2 due to infection and 3 to re-implant the electrode. One of the patients who had a reintervention due to infection died. Probability of survival was 93.8% in the first year and 90.3% subsequently up to the 10 years of follow-up. Event-free survival was 90.8% in the first year, 79.8% from year 5 to 9, 66.5% after 10 years. Conclusion: This study demonstrates the probability of satisfactory survival after epicardial pacemaker implantation, especially in patients with previous heart surgery. Epimyocardial electrode implantation deserves consideration in patients with small physical structure, those with specific cardiac malformations, and difficult access to superior vena cava or those who need to have an associated surgical procedure...(AU)