Key result
Implantation of a dual-chamber pacemaker in a pregnant woman with high-grade second-degree AV block and 15.8 seconds of asystole led to symptom resolution and successful delivery of a healthy infant.
Why the study?
Atrioventricular block in pregnancy is infrequently encountered and little management guidance is available.
Case Report (n=1)
No
Dual-chamber pacemaker implantation with fetal shielding can be safely and effectively performed in pregnant women presenting with symptomatic high-grade AV block.
Pacemaker implantation feasible for symptomatic Mobitz II AV block in mid-pregnancy; leaves open optimal timing, device selection, and prospective data.
Atrioventricular (AV) block in pregnancy is infrequently encountered and there is little management guidance available. We present a case of a 24-year-old G3P1011 at 24 weeks' gestation who presented to the obstetrics and gynecology clinic complaining of palpitations, fatigue, and dyspnea on exertion. Cardiology workup including an electrocardiogram (ECG) and Holter monitor detected second-degree type II (Mobitz) AV block with the longest asystole event lasting 15.8 seconds. A St. Jude's dual-chamber pacemaker (Abbott Laboratories, Abbott Park, IL) was implanted immediately. Standard radiation precautions were taken with additional shielding for the fetus. The patient experienced significant improvement in her symptoms. The patient went into labor at 37 3/7 weeks. Due to non-reassuring fetal heart tones, a cesarean section was performed, and a healthy baby girl was born. The management of heart block in pregnancy can be divided into involving those who are symptomatic and those who are asymptomatic. Symptoms of heart block can include palpitations, fatigue, dyspnea, and/or syncope; the presence of these symptoms warrants the placement of a pacemaker, preferably during pre-pregnancy or during the first two trimesters, as high-grade heart block is associated with significant mortality. Those who are in their last trimester or postpartum should consider the use of a temporary pacemaker as heart block could be due to pregnancy-related cardiovascular changes. For women with heart block, labor and delivery could result in worsening of bradycardia due to uterine contractions displacing blood into the central circulation. Most women with heart block do well in labor and delivery and having a pacemaker is not necessarily an indication for a cesarean section.
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Sullivan et al. (2020) conducted a case report in Atrioventricular block in pregnancy (n=1). Dual-chamber pacemaker implantation was evaluated on Symptom improvement and pregnancy outcome. Implantation of a dual-chamber pacemaker in a pregnant woman with high-grade second-degree AV block and 15.8 seconds of asystole led to symptom resolution and successful delivery of a healthy infant.
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