Congenital Complete Heart Block Complicated by Atrial flutter Diagnosis and Management

Figures

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  Fig. 1. Fetal echocardiography. A) axial view at the 4 chamber level showing a normal 4 chambers with mild pericardial effusion (Arrow). B) Sagittal view showing the chest and abdomen of the fetus, with mild pericardial effusion (Arrow). C) LV Inflow/outflow Pulse-Doppler showing mitral inflow atrial (A) more than ventricular (V) aortic outflow waves. C) M Mode: the cursor line cuts the right ventricular (RV) anterior wall and the left atrial (LA) wall (Atrial rate (A) is 153, and ventricular rate (V) is 55 bpm.

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  Fig. 2. 12 lead ECG showing complete heart block with atrioventricular dissociation. There is junctional escape rhythm, with narrow QRS complexes and a ventricular rate of 53 bpm.

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  Fig. 3. 12 lead ECG showing atrial flutter with complete heart block with atrioventricular dissociation and almost 6 to 1 AV block. There is junctional escape rhythm, with narrow QRS complexes and a ventricular rate of 51 bpm.

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  Fig. 4. Twenty-four-hour Holter monitoring, sample strip rhythm showing atrial flutter with an atrial rate of 300 bpm, narrow complex QRS complexes indicating a junctional escape rhythm, with a ventricular rate of 54 bpm.

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  Fig. 5. (A and B)12 lead ECG pre-cardioversion (5A) as well as post cardioversion (5 B). Pre-cardioversion the atrial rate is above 300 and the ventricular rate is around 55 bpm. Post-cardioversion there is a return of organized atrial rhythm with complete heart block and junctional escape rhythm (narrow QRS complexes) with a ventricular rate of 53 bpm.