PEDIATRICS Vol. 108 No. 3 September 2001, pp. 698-702

Breath-Holding Spells Associated With Significant Bradycardia: Successful Treatment With Permanent Pacemaker Implantation

Received Jun 13, 2000; accepted Mar 9, 2001.

Amy M. Kelly^*, Co-burn J. Porter^*, Michael D. McGoon, Raul E. Espinosa, Michael J. Osborn, and David L. Hayes

From the ^* Department of Pediatric and Adolescent Medicine and the  Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Objective.  To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with permanent pacemaker implantation.

Methods.  The records of pediatric patients who had apparent breath-holding spells and associated bradycardia and were treated with permanent pacemaker implantation were reviewed.

Results.  Ten pediatric patients with apparent breath-holding spells associated with bradycardia were treated with a permanent ventricular demand pacemaker at the Mayo Clinic between 1985 and 1995. Patients had onset of symptoms between ages 6 days and 12 months and presented for evaluation between ages 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms documented asystolic pauses of 1.7 to 24 seconds (mean: 11.9 seconds). Permanent ventricular demand pacemakers were implanted at 10 months to 5 years of age (median: 14.5 months): 9 endocardial and 1 epicardial. Three patients required pacemaker revision. At follow-up of 38 to 170 months (median: 65.5), 5 patients had complete resolution of spells, 2 had only mild color change without loss of consciousness or seizure activity, and 3 continued to have minor brief spells.

Conclusions.  Permanent pacemaker therapy for children with pallid breath-holding spells associated with severe bradycardia is safe, efficacious, and warranted.  Key words:  bradycardia, breath-holding spells, pacemaker.

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