Recurrent Syncope in a 27-Year-Old Primigravida

BACKGROUND: Complete atrioventricular block (CAVB) is a rare condition during pregnancy that poses significant risks to both the mother and the fetus. Its management requires a multidisciplinary approach to ensure maternal and fetal safety. CASE SUMMARY: A 27-year-old primigravida at 28 weeks of gestation presented with recurrent syncopal episodes. Electrocardiography confirmed complete atrioventricular block, and 24-hour Holter recording showed advanced atrioventricular block. Given her symptomatic presentation, a single-chamber permanent pacemaker was implanted under local anesthesia. The procedure was uneventful, and the patient remained hemodynamically stable throughout the intrapartum and postpartum periods. Close monitoring was maintained, and she delivered a healthy baby trans-vaginally at term. DISCUSSION: The management of CAVB during pregnancy is challenging because of the physiologic changes in pregnancy and the potential impact on the fetus. Although asymptomatic patients may be managed conservatively, pacemaker implantation is necessary for symptomatic cases to prevent complications such as syncope, heart failure, or sudden cardiac arrest. The literature highlights the safety and efficacy of permanent pacemaker implantation during pregnancy when performed with appropriate precautions. This case underscores the importance of early recognition, prompt intervention, and a collaborative approach among specialists to optimize outcomes for both the mother and the fetus. TAKE-HOME MESSAGES: CAVB during pregnancy requires individualized management, and symptomatic cases benefit from timely pacemaker implantation. A multidisciplinary approach is critical for successful maternal and fetal outcomes.