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[Predictive factors for late complete atrio-ventricular block after surgical treatment for congenital cardiopathy]
E Villain1, F Ouarda, C Beyler
1Hôpital Necker Enfants-Malades, cardiologie pédiatrique, 149, rue de Sèvres, 75015 Paris.
Insights
Late complete atrio-ventricular block (CAVB) after heart surgery is rare but can cause sudden death. Children with CAVB lasting over 48 hours post-surgery and ECG changes face a risk of late CAVB.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Pediatric Cardiac Surgery
Context:
- Late complete atrio-ventricular block (CAVB) is a rare complication following cardiac surgery.
- This complication is associated with late sudden death in pediatric patients.
- Predicting late CAVB is crucial for timely intervention and improved outcomes.
Purpose:
- To identify predictive factors for late complete atrio-ventricular block (CAVB) after cardiac surgery.
- To analyze the clinical and electrocardiographic findings in patients who developed late CAVB.
- To establish criteria for identifying high-risk patients requiring further electrophysiological evaluation.
Summary:
- A retrospective review of 11 patients with late CAVB post-cardiac surgery identified key predictors.
- Patients with immediate post-operative CAVB lasting >48 hours and subsequent ECG changes (altered QRS and/or prolonged PR interval) are at risk.
- Infra-Hisian block identified via electrophysiology necessitates cardiac stimulator implantation.
Impact:
- This study provides crucial insights into predicting late CAVB in pediatric cardiac surgery patients.
- Early identification of high-risk individuals can lead to timely interventions, potentially preventing sudden cardiac death.
- Recommendations for electrophysiological studies and pacemaker implantation in specific patient groups aim to improve long-term prognosis.
Abstract:
The late occurrence of complete atrio-ventricular block (CAVB) after cardiac surgery is rare but potentially responsible for cases of late sudden death. We searched for factors allowing prediction of this complication, retrospectively reviewing the case notes of 11 patients in hospital with complete AVB, 2 months to 10 years after correction of a cardiac malformation. All had a normal pre-operative ECG. The diagnosis had been made based on symptoms in 8 patients: syncope or collapse (4 cases) symptoms on effort (3 cases) or fatigue (1 case). In the others the diagnosis had been made on ECG. The block was infra-His in 5 patients who had electrophysiology. ECG analysis showed that all the patients had CAVB immediately post-operatively lasting 3-14 days. After restoration of conduction the ECGs showed the following anomalies compared to the pre-operative ECGs: long PR (1 case), long PR + right bundle branch block (2 cases), long PR + left axis deviation (1 case), RBBB + left deviation or rotation of the QRS axis (3 cases), long PR + RBBB + left axis deviation (4 cases). All of these patients had been fitted with a cardiac stimulator. In conclusion, the children who had CAVB immediately post-operatively lasting more than 48 hours and who then had an ECG showing different QRS compared to the pre-operative QRS and/or long PR had a risk of late complete AVB. These patients should have electrophysiology and a stimulator must be implanted in those who have an infra-His block.
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