Perinatal multidisciplinary management for neonates with prenatally-diagnosed congenital complete heart block undergoing early epicardial pacemaker implantation: a retrospective single-center case series

OBJECTIVE: To report our single-center multidisciplinary perinatal experience for neonates with prenatally diagnosed isolated congenital complete heart block (CCHB) requiring early epicardial pacemaker implantation. METHODS: This retrospective case series included four consecutive neonates with prenatally diagnosed isolated CCHB (2016-2020). A multidisciplinary team coordinated perinatal planning. Maternal data, fetal echocardiography, delivery-room resuscitation, vasoactive support, and short-term neonatal outcomes were analyzed descriptively. RESULTS: Four neonates (gestation 35 + 6-37 + 6 weeks; birth weight 2270-2500 g) were delivered by cesarean section. Umbilical vein catheterization was achieved rapidly in all. All neonates had a heart rate <50 bpm at birth and received immediate vasoactive resuscitation. All neonates underwent successful epicardial permanent pacemaker implantation within 10 days after birth with improved cardiac function and were discharged home. One infant was readmitted 8 days after discharge due to pocket infection and ultimately died on postnatal day 46. CONCLUSIONS: Multidisciplinary coordination, early umbilical-vein access, and individualized vasoactive support are critical for managing these high-risk neonates. Our findings provide practical guidance but require validation in larger cohorts.