Complete heart block in pregnancy presumed due to viral myocarditis may resolve with conservative management and observation, avoiding the need for pacemaker implantation.
May support conservative management in select pregnancy AV block cases; leaves open need for prospective data before practice change.
A pregnant woman presented with increasing exertional dyspnea and was found to have complete heart block with a junctional escape rhythm. The complete heart block did not resolve with exercise testing, suggesting infranodal disease. A presumptive diagnosis of mild viral myocarditis was made, having been exposed to her toddler with a viral exanthem days before. After giving steroids to preemptively accelerate fetal lung maturity and several days of close observation, the AV block resolved. She was discharged in stable condition without need for temporary or permanent pacing and later delivered a healthy infant.
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Fiser et al. (2017) studied this question.
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