Complete heart block in pregnancy: case report, analysis, and review of anesthetic management

Complete heart block in pregnancy

“…Pacing is not necessarily indicated when no symptoms are present. [2] Evaluation of chronotropic competence can also be achieved with atropine and is a key step to determine whether a pacemaker will be necessary. [3] Atropine was avoided in this patient due to uncertainty of its effect upon the fetus, and a similar evaluation of chronotropic competency was established with moderate exercise.…”

Cesarean section under spinal anesthesia in acquired complete atrioventricular block without a pacemaker: A case report

“…Previous reports have described the indication of temporary PMs in patients undergoing C‐section with congenital CAVB. Some of them suggested that implantation of a PM prior to C‐section is unnecessary in an asymptomatic pregnant with congenital CAVB . However, case reports describing C‐section in pregnancy with acquired CAVB without insertion of a temporary PM are limited .…”

“…Indeed, rapid onset of spinal anesthesia could cause hemodynamic instability. Furthermore, blocking of a cardiac branch of the sympathetic trunk could induce bradycardia and the Bezold‐Jarisch reflex could exacerbate bradycardia and hypotension . Together, these factors could explain avoidance of spinal anesthesia.…”

“…However, it may not be suitable to choose epidural anesthesia in an emergent situation because it takes much more time than spinal anesthesia. General anesthesia with inhaled or intravenous agents could have potential risks of altering the hemodynamic status significantly . Therefore, it is necessary to consider the indication of spinal anesthesia in pregnancies with acquired CAVB.…”

“…Kumar et al reported successful management of C‐sections in asymptomatic congenital CAVB under spinal anesthesia with PM placement, and Mohapatra et al reported successful management of emergent C‐section in asymptomatic congenital CAVB using spinal anesthesia without a PM . Sundararaman et al also reported successful management of vacuum‐assisted delivery in asymptomatic congenital CAVB under combined spinal‐epidural anesthesia . Thus, management for C‐sections in acquired CAVB should not be limited to general or epidural anesthesia.…”