AEPC 2022 - 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology , Geneve, Switzerland, 25 - 28 May 2022, pp.480
CLINICAL CHARACTERISTICS AND MID-TERM FOLLOW-UP FINDINGS IN CHILDREN WITH ISOLATED
COMPLETE HEART BLOCK: A SINGLE-CENTER TEN-YEAR EXPERIENCE
Ayse Sulu1, Hasan Candas Kafali1, Serhat Bahadir Genc2, Ismihan Selen Onan2, Sertac Haydin2, Alper
Guzeltas1, Yakup Ergul1
1Department of Pediatric Cardiology, Saglik Bilimleri University M. Akif Ersoy Thoracic and
Cardiovascular Surgery Center, Istanbul, Turkey
2Department of Pediatric Cardiovascular Surgery, Saglik Bilimleri University M. Akif Ersoy Thoracic
and Cardiovascular Surgery Center, Istanbul, Turkey
BACKGROUND AND AIM: Isolated complete atrioventricular block (CAVB) is a rare disease often
associated with maternal autoantibodies. It may occur with or without structural heart disease.
Although some of the patients are diagnosed in the prenatal and neonatal periods, the diagnosis
rate in childhood is quite high. In this study, we aim to present the data of our patients diagnosed
with isolated CAVB.
METHODS: In this study, we evaluated 108 patients diagnosed with isolated CAVB between 2011 and
2021. Demographic data of the patients, electrocardiography, echocardiography, 24-hour Holter
monitoring data and follow-up and complications of the patients who underwent pacemaker
implantation were evaluated retrospectively from hospital records.
RESULTS: The mean age at diagnosis of the patients was 5.51±5.05 years. At the time of diagnosis,
74.8% of the patients had no symptoms associated with AV block. The most common symptom was
fatigue. 25% of the patients were diagnosed in the first month of life. Echocardiography were normal
in 42 patients, left ventricle (LV) dilatation in 14 patients at baseline. Mitral valve regurgitation was
mild in 48 patients, significant in one, and moderate in 2 patients. Pacemaker implantation was
needed in 87 patients during follow-up. The most common pacemaker implantation indication was
significant bradycardia. The mean battery life was 5.41±2.65 years, Replacement-free period of 68
patients who underwent pace implantation and continued their follow-up was 4.18±2.89 (0.1-10)
years. The replacement-free period was 98.5% in the 1st year, 85% in the 5th year, 74.5% in the 7th
year. Pacemaker-related complications developed in 8 patients during follow-up. LV dysfunction
developed (dyssynchrony induced) in 3 patients at follow-up, and all were paced from the right
ventricle anterior wall. All of these patients underwent cardiac resynchronization therapy (CRT) and
LV dysfunction improved.
CONCLUSIONS: Isolated CAVB is a rare disease requiring careful clinical follow-up. Patients are often
asymptomatic and the most common indication for pacemaker implantation is significant
bradycardia. LV dysfunction is an important cause of morbidity, especially in patients with right
ventricular anterior wall pacing. Physicians should be aware of LV dysfunction during follow-up. CRT
should be considered as a treatment option for LV dysfunction.