Successful pregnancy outcome with cardiac pacemaker after complete heart block

Syncope in a pregnant woman with repaired Tetralogy of Fallot: a case report

Background

Tetralogy of Fallot (TOF) is one of the most widespread cyanotic congenital heart disease (CHD), which can be successfully repaired in the neonatal period. However, residual problems and the surgical technique itself can create a favourable basis for arrhythmias and conduction abnormalities in these patients. Sometimes, these arrhythmias may worsen during pregnancy and require urgent intervention.

Case summary

This is a case of a 25-year-old woman, who underwent a surgical repair of TOF at the age of 2 years. She suffered an ischaemic stroke postoperatively, which was complicated with secondary seizures and syncope. These episodes were evaluated as epilepsy. The patient was admitted to our hospital with the above-mentioned complaints in the 10th week of pregnancy. A comprehensive cardiac examination was performed. Her presyncopal event was captured during Holter monitoring, which documented a severe dysfunction of the sinus node. She was diagnosed with postoperative sick sinus syndrome and implanted with a permanent dual-chamber pacemaker (PM). After the operation, the patient did not have any episodes of syncope or seizures and the PM check-up showed almost 30% of atrial pacing.

Conclusion

No matter how obvious the neurological or other nature of syncope may seem, it is advised to exclude the cardiac origin of syncope, especially in patients with repaired CHD. One of the most common complications after surgery of CHD is rhythm and conduction disturbances. In some of these cases, permanent PM implantation can be unavoidable, even during pregnancy. The implantation of the PM device during pregnancy can be performed safely.

Total atrioventricular block in pregnancy -Case report

Introduction and importance

Bradycardia in pregnancy due to total atrioventricular block (TAVB) is a rare occurrence, often asymptomatic and may arise from a congenital disorder. Pacemaker is often required. Cases are few and management is not yet standardised.

Case presentation

A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards.

Clinical discussion

TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications.

Conclusion

Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.

Utility of the NavX® Electroanatomic Mapping System for Permanent Pacemaker Implantation in a Pregnant Patient with Chagas Disease

Chagas disease is a highly prevalent zoonosis in Mexico, Central, and South America. Early cardiac involvement is one of the most serious complications of this disease, and conduction disturbances may occur at an early age. We describe a young pregnant woman with Chagas disease and a high degree atrioventricular block, who required implantation of a permanent dual chamber pacemaker. Using an electroanatomic navigation EnSite NavX® system the pacemaker was successfully implanted with minimal fluoroscopic exposure. This case demonstrates the safety and feasibility of using an electroanatomic navigation system to guide permanent pacemaker implantation minimizing x-ray exposure in pregnant patients.

Management of complete heart block during pregnancy

A 22-year-old second gravida presented to the antenatal clinic at 28 weeks of gestation with frequent fainting attacks (2-3 episodes/day), palpitations and dyspnea (New York Heart Association Functional Classification II). Her pulse rate was 40 b.p.m. A 12-lead electrocardiogram and 24-h Holter revealed complete heart block. A transvenous permanent pacemaker (ventricular demand rate-responsive), paced at a rate of 60 pulses/min, was successfully implanted. A multidisciplinary approach was taken and the patient delivered a healthy baby boy of 2.8 kg at 38 weeks. She remained asymptomatic and was discharged in good condition. Management varies from expectant management to temporary pacemaker insertion to permanent pacing during pregnancy. In a young patient with sinus bradycardia, the primary criterion for a pacemaker is the concurrent observation of a symptom (e.g., syncope) with bradycardia (e.g., heart rate 35-40 b.p.m. or asystole for 3 s). Symptomatic pregnant women should always be counseled for a permanent pacemaker.

A case of an acquired high-degree AV block in a pregnant woman

Acquired heart block during pregnancy is rare. We describe the case of a 29-year-old pregnant female with fatigue due to an unexplained high-degree AV conduction disorder. She was treated with a dual chamber pacing system. Further pregnancy and delivery were without complications. The sparse literature on this topic is reviewed. (Neth Heart J 2008;16:419-21.).

Short communication: Is intrapartum temporary pacing required for women with complete atrioventricular block? An analysis of seven cases

Women with complete atrioventricular heart block without a permanent pacemaker normally receive temporary pacing for labour and birth. Here, we report seven women who were managed without pacing. All women had a temporary pacing lead inserted prior to induction of labour, but none of the women required pacing during labour or birth. Our experience suggests that women with complete atrioventricular block and without permanent pacing do not routinely require temporary pacing for labour and birth.