Breath-holding spells associated with significant bradycardia: Successful treatment with permanent pacemaker implantation

Objective. To determine whether children with pallid breath-holding spells associated with bradycardia can be treated safely and successfully with per manent 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 associa ted with bradycardia were treated with a permanent ventricular demand pacem aker at the Mayo Clinic between 1985 and 1995. Patients had onset of sympto ms between ages 6 days and 12 months and presented for evaluation between a ges 12 months and 5 years. Duration of spells was 15 seconds to 10 minutes. Medications to prevent spells were unsuccessful. Electrocardiograms docume nted 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 requ ired 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 w ithout loss of consciousness or seizure activity, and 3 continued to have m inor brief spells. Conclusions. Permanent pacemaker therapy for children with pallid breath-ho lding spells associated with severe bradycardia is safe, efficacious, and w arranted.