Experience with 40 children who developed complete heart block after open intracardiac repair of congenital heart disease is described. The incidence of this complication over a twelve-year periodfellfrom 25 tO IO per cent. The incidence ofpermanent complete heart block has fallen to less than 2 per cent.The mortality rate in the immediate postoperative period (27-5%) was twice that of patients without complete heart block. Twenty-nine patients survived the immediate postoperative period. Eighteen (62%) reverted to sinus rhythm, ii (38%) developed permanent complete heart block, and this group had a high mortality without pacemaker implantation. Of 9 medically treated patients, 6 succumbed (67%). The mode of death in all instances was a syncopal episode. Three patients have permanent pacemakers and lead active, normal lives.The occurrence of an Adams-Stokes attack as an indication for pacemaker implantation was unsatisfactory because the first attack was fatal in 4 patients. Criteria such as the presence of residual lesions, response to sympathomimetic drugs, and the width of the QRS complex were also of limited usefulness.The uncertainty of the prognosis has led to a policy ofpacemaker implantation in all patients with surgically induced permanent complete heart block regardless of symptomatology.
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