Abstract Ref Number = APCP775
EARLY PACEMAKER IMPLANTATION IN NEWBORN WITH CONGENITAL COMPLETE ATRIOVENTRICULAR HEART BLOCK
Anderson Supanto,Martinus Nuherwan Desyardi,Mia Kantiasih Rajasa,Prianto ,Sukman Tulus Putra,Rinawati Rohsiswatmo,Wiku Andonotopo,Hermawan
Eka Hospital BSD
Background : Congenital complete atrioventricular heart block (CAVB) is a rare pathology with a rate of incidence of one in every 14 000-22 000 live births. Early pacemaker implantation is needed to prevent cardiac arrest, although in most cases the procedure is not conducted due to late establishment of diagnosis and intervention. Pacemaker implantation in neonates with CAVB is a challenging procedure because of age, body size, presence of concomitant structural heart defects, and rapid child growth.
Case Presentation Summary : A baby girl weighing 3.35 kg was delivered by emergency caesarian from a 36-year old secundigravida diagnosed with fetal distress with severe continuous bradycardia. Three hours after delivery, bradycardia was detected on the newborn, and CAVB appeared on ECG. Initial drug therapy proved ineffective, and heart rhythm remained at 81 bpm. Echocardiography was later performed and showed an atrial septal defect. An early temporary pacing was implanted with initial setting 150 bpm, output 2 mA, and sensitivity 3 mV. Pacing was effectively performed, and ECG showed a pacing rhythm of 151 bpm. A permanent pacing system with unipolar electrodes (Medtronic Capsure, Medtronic inc, Minneapolis, USA) and Medtronic SEDR01 Sensia® pulse generator was implanted on the fifteenth day of life. Pace control were uncomplicated, and the baby was discharged home fifteen days after surgery without additional medication. Four months follow up to pediatrics clinic, wound re-suturing was performed due to pocket related complication, and skin erosion.
Learning Points/Discussion : The diagnosis of CAVB should be detected during pregnancy to enable early management. Ventilation and initial drug therapy admitted to newborns with CAVB proved ineffective. Pacing should be conducted immediately after delivery to prevent cardiac arrest. The procedure of early temporary pacemaker implantation and planned permanent pacemaker implantation were safe and effective, as a benefit from an effective early diagnostic and institutions collaboration.
Keywords: congenital complete atrioventricular block temporary pacing permanent pacemaker implantation pediatric cardiac surgery