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Outcomes in congenital and childhood complete atrioventricular block: A meta-analysis

Saurabh Deshpande1, Jayaprakash Shenthar1, Dibbendhu Khanra2

  • 1Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India.

Journal of Cardiovascular Electrophysiology
|January 12, 2022
PubMed

Insights

Pacemaker implantation for congenital and childhood complete atrioventricular block (CCAVB/CAVB) shows a 5.7% mortality rate and low incidence of pacing-induced cardiomyopathy (PICM). This suggests pacing is an effective management strategy with few long-term side effects.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Electrophysiology

Background:

  • Long-term outcomes for congenital and childhood complete atrioventricular block (CCAVB/CAVB) post-pacemaker implantation remain unclear.
  • CCAVB/CAVB is a rare condition requiring lifelong management.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the long-term outcomes of CCAVB/CAVB patients after pacemaker implantation.
  • To determine the pooled mortality and incidence of pacing-induced cardiomyopathy (PICM) in this population.

Main Methods:

  • Systematic search of PubMed and CENTRAL databases (1967-2020).
  • Meta-analysis of 29 studies including 1553 patients.
  • Quality appraisal using the Newcastle-Ottawa scale and restricted maximum likelihood function for data analysis.

Main Results:

  • Pooled all-cause mortality was 5.7% (95% CI: 2.5%-9.9%).
  • Pacing-induced cardiomyopathy (PICM) incidence was 3.8% (95% CI: 1.2-7.2).
  • Diagnosis at birth, congenital heart disease, younger age at implantation, and pacing duration were associated with higher mortality in univariate analysis, but not in multivariate analysis.

Conclusions:

  • Pacemaker implantation for CCAVB/CAVB is an effective management strategy with a low incidence of long-term side effects.
  • Pooled mortality is 5.7% and PICM incidence is 3.8%, indicating favorable outcomes.
  • Further registry and randomized data are needed to fully elucidate the natural history and optimal management strategies.
Abstract

Keywords:
cardiomyopathychildhood complete atrioventricular blockcongenital complete atrioventricular blockmortality

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