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[Permanent pacemaker with implantation in a young child with congenital complete atrioventricular block: a case
1Department of Pediatrics, Kaohsiung Medical College, Taiwan, Republic of China.
Insights
Congenital atrioventricular block requires pacemaker implantation when medical treatments fail. This case study shows successful VVI pacemaker use in a child, improving heart function and preventing syncope.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
Background:
- Congenital atrioventricular block (A-V block) is a disorder of the heart's electrical system present from birth.
- Pacemaker implantation is the primary treatment for congenital A-V block when medical interventions are ineffective.
Observation:
- A 15-month-old male infant presented with recurrent respiratory infections, bradycardia, and complete A-V block.
- The patient experienced syncope and Stokes-Adams syndrome despite medical management.
- Criteria for pacemaker implantation in children include syncope, heart failure, slow heart rate, arrhythmias, ECG changes, and exercise intolerance.
Findings:
- A VVI mode epicardial pacemaker was implanted in the infant.
- Post-implantation, the patient showed dramatic improvement in heart function and respiratory status.
- The patient remained stable with a regular heart rhythm during a 4-year follow-up period.
Implications:
- Epicardial pacemaker implantation can be a safe and effective treatment for congenital A-V block in infants.
- This intervention significantly improves clinical outcomes, including resolution of syncope and enhanced physiological function.
- Long-term follow-up confirms the stability and efficacy of pacemaker therapy in pediatric congenital heart block.
Abstract:
Congenital atrioventricular block is a congenital disorder of the cardiac conducting system. Pacemaker implantation is the treatment of choice for patients with congenital A-V block if prior medical treatment fails. The criteria for pacemaker implantation in infants and children are (1) frequent syncope (2) heart failure (3) ventricular rate below 55 beats/min (4) ventricular arrhythmia (5) QRS widening in the ECG (6) moderate to severe exercise intolerance. Our experience with a 15-month-old male child is herein presented. The patient suffered from frequent attacks of upper respiratory tract infection, bradycardia and complete A-V block as found on electrocardiograms. At 15 months old, he was admitted again due to respiratory tract infection and several attacks of syncope. Stokes-Adams syndrome was noted several times despite medical treatment. Following implantation of a VVI mode epicardiac pacemaker, the patient's condition, including resistance to heart failure and respiration, were improved dramatically. He was followed up regularly for 4 years, his heart beat remaining stable.