Recovery from congenital complete atrioventricular block

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Congenital Heart Disease

Background:

• Congenital complete atrioventricular block (CCAVB) is a rare condition often requiring lifelong pacemaker support.
• CCAVB can present with severe symptoms like heart failure and Adams-Stokes attacks in infancy.
• The natural history and potential for resolution of CCAVB without intracardiac anomalies are not well-defined.

Observation:

• A female infant diagnosed with isolated CCAVB experienced significant symptoms including heart failure and Adams-Stokes attacks at 1 year of age.
• Pacemaker implantation was necessary to manage the severe bradycardia and associated symptoms.
• Continuous monitoring was essential to track the progression and stability of the cardiac rhythm.

Findings:

• At 7 years of age, the patient demonstrated a spontaneous reversion to normal sinus rhythm, confirmed by electrocardiography.
• Treadmill testing at the same age revealed a normal cardiac response to exercise, with no arrhythmias detected.
• This spontaneous resolution of CCAVB is an exceptionally rare clinical occurrence.

Implications:

• This case highlights the possibility of spontaneous recovery from congenital complete atrioventricular block, challenging the assumption of lifelong dependency on pacemakers.
• It suggests a potential for natural resolution in select cases of isolated CCAVB, warranting further investigation into predictive factors.
• Clinicians should consider the long-term possibility of rhythm normalization when managing pediatric patients with CCAVB, potentially influencing management strategies and follow-up protocols.