Congenital Complete Heart Block Requiring Temporary Pacemaker Placement at Birth: A Case Report

Congenital heart block (CHB) is a rare congenital cardiac disease where disruption of the atrioventricular (AV) node results in cardiac conduction abnormalities. The majority of CHB cases are associated with neonatal lupus antibodies that are associated with autoimmune destruction and fibrosis of the AV node, most commonly resulting in a congenital complete heart block (CCHB). We report the case of a 23-year-old mother who was found to have a fetus with significant bradycardia at a 21-week anatomy ultrasound. Subsequent fetal echocardiograms demonstrated a third-degree heart block, and laboratory workup of the mother was positive for SSA antibodies. Successful care of the fetus required multidisciplinary coordination to ensure adequate antepartum care, successful delivery of the fetus, and proper cardiovascular management of the neonate after birth. We discuss etiologies of fetal bradycardia, proper imaging techniques to diagnose fetal cardiac abnormalities, and the management of a neonate with CCHB after birth. Lastly, we emphasize how adequate operating room preparation and multidisciplinary planning are essential for optimal outcomes during time-sensitive and high-risk operating room procedures.