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Heart Block in Unpalliated Complex Adult Congenital Heart Disease: Massive Collateral Burden Precludes Epicardial

Joshua R Hirsch1, Christopher R Broda2, Peter R Ermis2

  • 1Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.

JACC. Case Reports
|July 28, 2021
PubMed

Insights

Complete heart block in adults with congenital heart disease (CHD) poses challenges. For patients with septal shunting, epicardial pacing is preferred to reduce thromboembolism risk, but complex CHD anatomy can complicate lead placement.

Area of Science:

  • Cardiology
  • Congenital Heart Disease
  • Cardiac Electrophysiology

Background:

  • Complete heart block is a frequent complication in adults with congenital heart disease (CHD).
  • Epicardial pacing is the recommended approach for patients with septal shunting to mitigate thromboembolism risks.
  • Complex anatomical variations in CHD can present challenges for traditional epicardial lead implantation.

Purpose of the Study:

  • To evaluate the efficacy and safety of endocardial pacing in adult CHD patients with complete heart block.
  • To address the challenges of epicardial lead placement in complex CHD anatomy.
  • To investigate the persistent question of thromboembolism risk reduction with endocardial pacing in this specific population.

Main Methods:

  • Review of existing literature on pacing strategies in adult CHD.
  • Analysis of case studies involving complete heart block and complex CHD anatomy.
  • Comparative assessment of thromboembolism risks between epicardial and endocardial pacing in CHD patients.

Main Results:

  • Epicardial pacing is associated with lower thromboembolism risk in CHD patients with septal defects.
  • Anatomical constraints in complex CHD can render surgical epicardial lead placement unfeasible.
  • The effectiveness of endocardial pacing in reducing thromboembolism for these complex CHD cases requires further investigation.

Conclusions:

  • For adult CHD patients with complete heart block and complex anatomy, endocardial pacing may be necessary when epicardial lead placement is not feasible.
  • The management of thromboembolism risk in these patients undergoing endocardial pacing remains an area of concern and requires further research.
  • Optimizing pacing strategies for adult CHD with complete heart block necessitates consideration of both anatomical feasibility and thromboembolic risk.

Keywords:
AV, atrioventricularCHD, congenital heart diseaseCT, computed tomographybradycardiacardiac pacemakercomputed tomographycyanotic heart diseasestrokeventricular septal defect

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