A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology

Abstract

We perceived an increased incidence of surgical atrioventricular (AV) block in patients with single ventricle physiology undergoing two ventricle rehabilitation for hypoplastic left heart syndrome compared to the overall incidence of surgical AV block for our institution. Retrospective investigation of our center's data revealed a statistically significant increase in the incidence of surgical AV block in the single ventricle population and two ventricle rehabilitation population compared to the two ventricle population. Here we review the literature with respect to historic definitions, incidence, risk factors, pre- and post-op management, current indications for pacemaker placement and added cost and comorbidity associated with surgical AV block. We then offer possible strategies for decreasing the incidence of surgical AV block within both the single and two ventricle populations.

Pacemaker treatment after Fontan surgery—A Swedish national study

“…The etiology is described as multifactorial; transection of the conduction system, as well as ischemia, edema, and blunt trauma as isolated features or in combination, are all described as probable causes of AV block. 16 We found no significant difference in mortality between patients In patients with DILV, the proportion with AV block as the indication for pacemaker was high. DILV shares anatomic features with double discordance.…”

“…Surgical AV block has been reported to have a significantly higher incidence in patients with univentricular heart defects (3.29%) compared to those undergoing intra‐cardiac surgery to biventricular repair (.87%). The etiology is described as multifactorial; transection of the conduction system, as well as ischemia, edema, and blunt trauma as isolated features or in combination, are all described as probable causes of AV block …”