Duration of complete atrioventricular block after congenital heart disease surgery

Complete heart block (CHB) may complicate surgery for congenital heart disease and is a category I indication for pacemaker implantation when conduction does not recover.1 The proper duration of observation before proceeding to permanent pacemaker implantation is still ill defined, but is broadly accepted as 10 to 14 days following surgery.1,2 The timing of permanent pacemaker implantation for postoperative CHB is of considerable practical importance, because delayed implantation results in added cost for hospital observation in otherwise stable patients, whereas too early implantation may result in an unnecessary operation and implantation of expensive devices resulting in additional risks and expense. We prospectively followed patients with CHB to better establish the timing for recovery of atrioventricular (AV) conduction, and to determine if there were factors that reliably predict permanent CHB. This information may be helpful in deciding which patients should receive a permanent pacing system, and may refine the optimal timing of such implants.