Pregnancy in sick sinus syndrome with pacemaker - two cases

Area of Science:

• Cardiology
• Maternal-Fetal Medicine
• Electrophysiology

Background:

• Sick sinus syndrome (SSS) is a cardiac condition affecting the heart's natural pacemaker, the sinus node.
• It can stem from external factors or internal sinus node disease, impairing its pacing function.
• Pregnancy can be the first presentation of SSS, posing unique clinical challenges.

Observation:

• Two cases of pregnant women diagnosed with sick sinus syndrome during gestation are presented.
• The first case, diagnosed at 8 weeks gestation, presented with Mobitz type I heart block (Wenckebach block) and required a temporary pacemaker during Cesarean section.
• The second case, diagnosed at 24 weeks gestation, developed complete heart block, necessitating a permanent pacemaker by 38 weeks gestation due to symptom exacerbation.

Findings:

• Both cases of sick sinus syndrome in pregnancy were successfully managed.
• Cesarean sections were performed under general anesthesia with close multidisciplinary collaboration.
• Cardiac pacing was essential for the safe delivery of both patients.

Implications:

• Pregnancy can unmask or exacerbate sick sinus syndrome, requiring vigilant cardiac monitoring.
• Multidisciplinary care involving cardiologists and anesthesiologists is crucial for managing SSS in pregnant patients.
• Timely cardiac intervention, including pacing, ensures favorable outcomes for mother and fetus in SSS pregnancies.