Caesarean section under spinal and epidural anesthesia in complete atrioventricular block without a pacemaker: a rare case report

Abstract

Complete heart block (CHB) during pregnancy is rarely encountered. Management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist, and neonatologist. Treatment varies from medical management to temporary or permanent pacemaker insertion. Complete atrioventricular block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. We successfully managed caesarean section in a pregnancy with complete atrioventricular block under spinal and epidural anesthesia without a pacemaker. Asymptomatic pregnant women with congenital complete atrioventricular block can tolerate caesarean section under spinal and epidural anesthesia without a pacemaker.