Asymptomatic Complete Heart Block in Pregnancy

Complete heart block (CHB) during pregnancy is rare, but it has been documented in case reports and small case series. Current guidelines recommend permanent pacemaker implantation in symptomatic patients, however management of asymptomatic cases is less well defined.

We present an asymptomatic 24-year-old gravida 1, para 0 woman incidentally found to be in complete heart block. Laboratory and imaging work-ups revealed no underlying etiology. She underwent a planned cesarean section owing to breech fetal presentation, during which a transvenous pacemaker was placed but not used. She is scheduled for consideration of pacemaker implantation as an outpatient.

Evaluation of CHB during pregnancy should include an assessment for potentially reversible or secondary causes. Patients should continue to be evaluated postpartum for both maternal and fetal complications.

Pregnant patients in CHB often have well-tolerated deliveries, provided they have a stable, narrow QRS escape rhythm. They generally do not need pacemaker implantation unless symptomatic.