PDF(Pubmed)
Abstract：
Guidelines are important tools to guide the diagnosis and treatment of patients to improve the decision-making process of health professionals. They are periodically updated according to new evidence. Four new Guidelines in 2021, 2022 and 2023 referred to pediatric pacing and defibrillation. There are some relevant changes in permanent pacing. In patients with atrioventricular block, the heart rate limit in which pacemaker implantation is recommended was decreased to reduce too-early device implantation. However, it was underlined that the heart rate criterion is not absolute, as signs or symptoms of hemodynamically not tolerated bradycardia may even occur at higher rates. In sinus node dysfunction, symptomatic bradycardia is the most relevant recommendation for pacing. Physiological pacing is increasingly used and recommended when the amount of ventricular pacing is presumed to be high. New recommendations suggest that loop recorders may guide the management of inherited arrhythmia syndromes and may be useful for severe but not frequent palpitations. Regarding defibrillator implantation, the main changes are in primary prevention recommendations. In hypertrophic cardiomyopathy, pediatric risk calculators have been included in the Guidelines. In dilated cardiomyopathy, due to the rarity of sudden cardiac death in pediatric age, low ejection fraction criteria were demoted to class II. In long QT syndrome, new criteria included severely prolonged QTc with different limits according to genotype, and some specific mutations. In arrhythmogenic cardiomyopathy, hemodynamically tolerated ventricular tachycardia and arrhythmic syncope were downgraded to class II recommendation. In conclusion, these new Guidelines aim to assess all aspects of cardiac implantable electronic devices and improve treatment strategies.
摘要：
指南是指导患者诊断和治疗以改善卫生专业人员决策过程的重要工具。它们会根据新的证据定期更新。2021年，2022年和2023年的四个新指南提到了儿科起搏和除颤。永久性起搏有一些相关变化。在房室传导阻滞患者中，我们降低了建议植入起搏器的心率限值,以减少过早植入起搏器.然而,强调心率标准不是绝对的，因为血流动力学不耐受的心动过缓的体征或症状甚至可能以更高的速率发生。在窦房结功能障碍中，有症状的心动过缓是最相关的起搏建议.当认为心室起搏量高时，越来越多地使用和推荐生理性起搏。新的建议表明，循环记录仪可以指导遗传性心律失常综合征的管理，并且可能对严重但不频繁的心悸有用。关于除颤器植入，主要变化是一级预防建议。在肥厚型心肌病中，儿科风险计算器已纳入指南.在扩张型心肌病中，由于罕见的心源性猝死在儿科年龄，低射血分数标准被降级为II级.在长QT综合征中，新的标准包括严重延长QTc，根据基因型有不同的限制，和一些特定的突变。在致心律失常性心肌病中，血流动力学耐受性室性心动过速和心律失常性晕厥降级为II级推荐.总之,这些新指南旨在评估心脏可植入电子设备的所有方面,并改进治疗策略.
