A Case of Complete Heart Block With Diagnostic Challenge and Therapeutic Dilemma

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Permanent pacemaker implantation is a Class I indication for symptomatic complete heart block.
• Congenital complete heart block (CCHB) can present asymptomatically, particularly in very young patients.
• Prophylactic pacemaker therapy in asymptomatic CCHB poses a therapeutic dilemma due to uncertain optimal timing.

Purpose of the Study:

• To present a case of asymptomatic CCHB with a junctional escape rhythm.
• To discuss the diagnostic challenges in such cases.
• To explore the treatment strategy considerations for prophylactic pacemaker implantation.

Main Methods:

• Case report presentation.
• Review of clinical presentation and diagnostic findings.
• Discussion of management strategies for asymptomatic CCHB.

Main Results:

• The patient presented with asymptomatic CCHB and a junctional escape rhythm.
• The escape rhythm demonstrated rate-incrementing capacity with physical activity, complicating diagnosis.
• The case highlights the challenges in determining the ideal timing for pacemaker implantation.

Conclusions:

• Asymptomatic CCHB requires careful consideration for pacemaker implantation, even with rate-responsive escape rhythms.
• The optimal timing for prophylactic pacemaker therapy in asymptomatic CCHB remains an unresolved clinical question.
• This case underscores the need for individualized management strategies in pediatric congenital heart block.