Pregnancy and complete atrioventricular block: a case report

Abstract

Introduction: Bradycardia in pregnancy due to complete atrioventricular block (CAVB) is a rare but serious occurrence that can be life-threatening to the mother and fetus. Patients with CAVB may be asymptomatic, but symptomatic cases require urgent and definitive management. Case presentation: The case of a 20-year-old primigravida with previously undiagnosed CAVB who attended the obstetric emergency service in labor is presented. The route of delivery was vaginal without complications. The decision was made to implant a permanent dual-chamber pacemaker on the third day of the puerperium, and the patient did no present cardiovascular symptoms during outpatient follow-up. Clinical discussion: CAVB is a rare but serious condition in pregnancy that can be congenital or acquired. While some cases are relatively benign, others can lead to decompensation and fetal complications. There is no consensus on the best delivery route, but vaginal delivery is generally safe unless contraindicated for obstetric reasons. Pacemaker implantation may be necessary in some cases and can be performed safely during pregnancy. Conclusion: This case highlights the importance of cardiac evaluation in pregnant patients, especially those with a history of syncope. It also highlights the need for adequate and urgent management in symptomatic cases of CAVB in pregnancy and adequate evaluation to decide when to implant the pacemaker as a definitive measure.

Navigating the Complexity: A Comprehensive Review of Managing Pregnancy in Complete Heart Block Cases

“…In 30% of patients with congenital heart block, the first symptoms occur during pregnancy, likely due to the hyperdynamic circulation of pregnancy. The best route of delivery for such patients is still under debate, and there is no absolute contraindication regarding vaginal delivery [ 30 ].…”

“…Pregnancy with CHB: A case report highlighted the importance of cardiac evaluation in pregnant patients, especially those with a history of syncope. It also emphasized the need for adequate and urgent management in symptomatic cases of CHB in pregnancy and adequate evaluation to decide when to implant the pacemaker as a definitive measure [ 30 ]. The best route of delivery for patients with congenital heart block is still under debate, and there is no absolute contraindication regarding vaginal delivery [ 30 ].…”