Related Experiment Videos
[Therapy and prognosis of infectious complete atrioventricular block in children]
G Batmaz1, E Villain, D Bonnet
1Service de cardiologie pédiatrique, Hôpital Necker-Enfants malades, Paris.
Insights
Sudden acquired complete atrioventricular block in children, often caused by myocarditis, can be severe but usually resolves with temporary pacing. Some cases may require permanent pacemakers.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Electrophysiology
Context:
- Studied ten children (6 days to 16 years) with complete atrioventricular block from 1983-1997.
- Block was likely due to myocarditis, with infectious causes identified in 4 cases.
- Symptoms included syncope, seizures, collapse, or asymptomatic bradycardia.
Purpose:
- Assess prognosis of sudden acquired complete atrioventricular block in children.
- Define optimal therapeutic strategies for this condition.
- Investigate the role of infective myocarditis.
Summary:
- Five children received intravenous isoprenaline, three developed ventricular tachycardia.
- Five were treated with steroids, three with antiviral agents; seven underwent temporary pacing.
- Outcomes included one death, six full recoveries, and three permanent blocks (two requiring pacemakers).
Impact:
- Sudden acquired complete atrioventricular block in children is often poorly tolerated.
- Transient pacing is a crucial treatment modality.
- While recovery is common, some cases result in definitive blocks requiring pacemakers.
Abstract:
From 1983 to 1997, we have studied ten children with complete atrioventricular block likely due to myocarditis in order to assess its prognosis and to define a therapeutic strategy. Their age ranged from 6 days to 16 years (median: 4.1 years). All were admitted for sudden complete block, with symptoms in seven: syncope or fainting, seizures, collapse. Three had an asymptomatic bradycardia which was detected on routine auscultation in children with fever or already hospitalized; fever was present in 5. The disease was related to infection on biological data in 4 cases (1 listeriosis and 3 seroconversions for Epstein Barr or cytomegalic or Coxsackie B viruses), on a myocardial biposy in 1 case and on scintigraphic data in 1 case. In the remaining 4, indirect arguments were considered such as infectious context, normal recent ECG, favourable outcome. Five children were given intravenous isoprenalin with ventricular tachycardia in 3. Five were treated with steroids and 3 with specific antiviral agents. Seven patients were paced temporarily. One child died, 6 recovered totally and 3 have a permanent block with a definitive pacemaker implanted in 2. In conclusion, sudden acquired complete atrioventricular blocks are often ill-tolerated in children and have to be treated with transient pacing. Recovery occurs as a rule but some of these blocks may be definitive. Infective myocarditis is likely to be the cause of the disease even if the pathogen agent cannot always be identified.