The course of severe breath-holding spells with prolonged asystoles in children after permanent pacemaker implantation: own results and literature review

Background. The breath-holding spells are reflex syncope in children, which are manifested during crying, screaming, discontent. The ECG during paroxysms shows episodes of asystole up to 30–70 seconds and bradycardia with a heart rate of 30–40 beats/min. Breath-holding spells disappear by the age of 3–5, but severe paroxysms with syncope and seizures sometimes need the pacemaker implantation. The course of breath-holding spells with pacemaker implantation have not been poorly studied.

The aim. To analyze the course of severe breath-holding spells with prolonged asystoles in children after permanent pacemaker implantation.

Materials and methods. We included 10 patients (aged 14–43 months) with breath-holding spells and syncope and implanted pacemaker. Electrocardiography, Holter monitoring and echocardiography were performed, the heart rate monitor was implanted in 3 patients.

Results. Provoking factors were screaming, pain, crying. In 60 % syncope were accompanied by seizures and asystoles lasting from 3 to 40 seconds were recorded. In 90 % syncope stopped after the pacemaker implantation, excluding one. One patient has reactive pericarditis. Pacemakers have been removed from 7 patients and replaced in 3 patients. In 6 out of 7 patients after pacemaker extraction syncope did not recur, one patient has reflex syncope.

Conclusion. The course of the breath-holding spells with prolonged asystoles after pacemaker implantation is associated with the disappearance of severe seizures in 100 % of children and relief from the syncope in 90 % of children. Complications of after the pacemaker implantation in children with severe breath-holding spells occur in 10 %.

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