A Lifeline Through the Umbilicus: Emergency Pacing in Neonatal Complete Heart Block-Uncorrected Proof

Area of Science:

• Neonatal Cardiology
• Pediatric Electrophysiology
• Maternal-Fetal Medicine

Background:

• Complete congenital atrioventricular heart block (CHB) is a rare, life-threatening neonatal condition.
• Often linked to maternal autoimmune connective tissue disease, CHB requires prompt management.
• Vascular access in premature infants for pacing can be technically challenging.

Purpose of the Study:

• To highlight the successful use of umbilical vein access for temporary transvenous pacing in a premature neonate with CHB.
• To present the umbilical vein as a viable alternative for emergency vascular access in challenging neonatal cases.

Main Methods:

• Case report of a premature neonate (35+1 weeks) with congenital third-degree heart block.
• Emergency temporary transvenous pacing via umbilical vein after failed femoral access.
• Successful bridging to permanent pacemaker implantation.

Main Results:

• The umbilical vein provided a rapid, bedside, and less invasive vascular access route.
• Emergency temporary pacing via the umbilical vein was successfully achieved.
• The neonate was stabilized and bridged to permanent pacemaker implantation.

Conclusions:

• Umbilical vein access is a valuable and effective alternative for emergency pacing in premature neonates when conventional routes fail.
• This approach can be lifesaving in cases of hemodynamic compromise due to CHB.
• Successful temporary pacing via the umbilical vein facilitates further management and improves outcomes for neonates with CHB.