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Pacemaker Management and In-Hospital Outcomes in Neonatal Congenital Atrioventricular Block
Matthew F Mikulski1, Andrew Well1, Daniel Shmorhun2
1Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
JACC. Clinical Electrophysiology
|June 24, 2023
Summary
Neonatal congenital atrioventricular block (nCAVB) is a rare condition with high mortality. Pacemaker placement is associated with decreased mortality in nCAVB patients, especially those without congenital heart disease (CHD).
Area of Science:
- Pediatric Cardiology
- Neonatal Medicine
- Electrophysiology
Background:
- Neonatal congenital atrioventricular block (nCAVB) is a rare condition associated with high mortality and frequent need for pacing.
- Limited data exists on in-hospital outcomes and pacemaker management for nCAVB.
Purpose of the Study:
- To analyze pacemaker management and in-hospital outcomes in neonates with nCAVB.
- To compare outcomes between nCAVB patients with and without congenital heart disease (CHD).
Main Methods:
- A multicenter database review of patients under 31 days old diagnosed with nCAVB from 2004 to 2022.
- Analysis of pacing interventions and in-hospital mortality using statistical models.
- Inclusion criteria excluded patients with cardiac surgeries other than pacemaker insertion.
Main Results:
- In-hospital mortality was 36.2% for nCAVB with CHD and 8.4% for nCAVB without CHD.
- Pacemaker insertion was associated with decreased in-hospital mortality, particularly when placed between 2-7 days of age.
- Temporary pacing wires were associated with increased mortality risk.
Conclusions:
- Congenital heart disease and prematurity are associated with increased in-hospital mortality in nCAVB.
- Pacemaker placement is linked to reduced mortality in nCAVB.
- Prospective registries are essential for better characterization and standardized management of nCAVB.
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