Perioperative management of children with third degree heart block undergoing pacemaker placement: a ten year review

It has been suggested that children with third degree heart block require insertion of a temporary pacemaker prior to general anaesthesia. This recommendation needs to be reevaluated with the availability of noninvasive transcutaneous cardiac pacing. We undertook a retrospective ten-year chart review of anaesthesia in children with third degree heart block undergoing pacemaker insertion or revision. Forty-eight children with complete heart block underwent seventy anaesthetics of which fifty three were in children without pacemakers or with nonfunctioning pacemakers. One child had a temporary pacemaker placed preoperatively following asystole in the emergency room. In children who were not being paced, 60% had baseline heart rates less than 60 bpm. Complications seen in this study, including hypotension, would not have been prevented by temporary pacemaker placement. We conclude that there is no benefit to routine preoperative temporary pacing in children with third degree heart block.