PP003 RARE CASE OF PACEMAKER FAILURE IN A CHILD

Abstract

Pacemaker insertion in a paediatric patient is rare and only represent 1 % of all pacemaker insertions . Indications for pacing in children are divided predominantly into three main groups: congenital conduction  abnormalities , acquired heart block post surgery for congenital defect correction and sinus node diseases. We present a case of a  child who presented  with pacemaker failure.

A 5 year old child presented to the emergency department (ED) with a brief history of possible  seizure . He was  found  unresponsive  with upper and lower limb stiffness  associated with  bowel and urinary incontinence and uprolling of eyeballs.He had never had seizures before and was otherwise well. He had a background history of congenital heart disease - Tetralogy of Fallot (TOF) and Pulmonary atresia ventricular septal defect (PAVSD). He developed complete heart block after multiple surgeries and  required pacemaker insertion . On presentation to the ED , patient was alert but was noted to have  heart rate of 50 bpm . He  was  otherwise haemodynamically stable. An electrocardiogram (ECG) done in ED revealed a complete third degree  atrioventricular block and pacemaker impulse-QRS dissociation . He was admitted to the paediatric ward ,diagnosed with pacemaker failure and transferred to a cardiac centre. He was noted to have myocardial fibrosis  at the pacemaker lead site and underwent an epicardial ventricular lead reimplantation.

Pacemaker failure can present in many ways which include  syncope, dizziness, palpitations,  brady or tachyarrthymias and even hiccoughs. Pacemaker malfunction can occur due multiple reasons ranging   from equipment failure to post cardiac surgery scarring and even patient manipulation. As more infants with  complex congenital cardiac defects are being successfully treated with surgical repair,the requirement for  permanent pacing is likely to increase .Hence the clinician has to be aware of this rare entity which might present more frequently in the future.