Pregnancy with complete heart block

Abstract

Pregnancy with complete heart block is rare, its management is not streamlined and requires a multidisciplinary team approach involving the obstetrician, cardiologist, anaesthesiologist and neonatologist. High index of suspicion in a woman with slow heart rate and electrocardiographic examination will ensure the diagnosis of this condition. Such patient can be managed conservatively or may require temporary or permanent pacemaker implantation. We present a 26-year-old primigravida with complete heart block at term pregnancy. She was asymptomatic throughout her pregnancy with pulse rate between 50 and 60 beats per minute. Vaginal delivery was planned under continuous ECG monitoring. Isoprenaline drip and temporary pacemaker were kept stand-by. However, for obstetric reasons caesarean section was performed successfully under spinal anaesthesia without a pacemaker. Method of anaesthesia was planned to keep the haemodynamics stable and drugs causing bradycardia were avoided.

Pregnancy and complete atrioventricular block: a case report

“…The finding of CAVB in pregnancy is rare; if present, it is usually congenital. About 30% of congenital CAVB cases remain undiscovered until adulthood and therefore may be first diagnosed during the gestational stage 8 . It can be acquired from secondary causes, such as ischemic heart disease, drug toxicity, nodal ablation, electrolyte disorder, and due to previous cardiac surgeries.…”

“…However, in other cases of CAVB, the heart rate does not increase and can become decompensated, especially in the last stages of pregnancy and during the second stage of labor or in the immediate postpartum period. Valsalva stimulates the vagus nerve and may exacerbate bradycardia, produce asystole, or cardiac arrest 4 , 8 .…”

“…Pacemaker implantation can be performed safely, especially if the fetus is more than 8 weeks pregnant 8 , 11 , 17 . There are several reports of women undergoing permanent pacing during pregnancy without significant adverse effects; in some cases, transesophageal echocardiography was used to guide lead position and in others electroanatomical navigation minimizing the use of fluoroscopy 17 .…”

Atrioventricular block in patients with hyperthyroidism: a narrative review

“…This results in complete dissociation between the atria and ventricles and is characterized on an ECG by regular P-P and R-R intervals with an irregular P-R interval. 10 The global prevalence of AVB is unknown. A nationwide analysis of 15 million people in China revealed a 7.06% overall prevalence of all types of AVB.…”

“…This results in complete dissociation between the atria and ventricles and is characterized on an ECG by regular P-P and R-R intervals with an irregular P-R interval. 10…”