Late recovery of surgically-induced atrioventricular block in patients with congenital heart disease.
OBJECTIVE
To assess the incidence and establish possible predictors of late recovery of post-surgical heart block, treated with pacemaker implantation, in patients with congenital heart defects.


BACKGROUND
The American College of Cardiology/American Heart Association Task Force has recommended pacemaker implantation for advanced second or third degree atrioventricular block which persists for 7 to 14 days after surgery. The incidence of late recovery of post-surgical heart block following pacemaker implantation has not been reported.


METHODS
Records of 44 patients with post-surgical heart block who underwent pacemaker implantation at our institutions since 1976 were reviewed for demographic, anatomic, surgical and surface electrocardiographic data to assess the incidence of, and factors associated with, recovery of atrioventricular conduction on long-term follow-up.


RESULTS
32% (14) of patients recovered atrioventricular conduction at a median follow-up of 5.5 years while 68% (30) remained pacemaker dependent. The groups were similar in age and weight at surgery and period of follow-up p = 0.5). Types of defect and surgical repair were not significantly different (p > 0.1). There was a similar number of patients with second degree-type II block in both groups (p = 0.15). The groups did not differ in timing of pacemaker implantation (<10 days p = 0.14, >14 days p = 0.18).


CONCLUSIONS
Late recovery of atrioventricular conduction following pacemaker implantation for postsurgical heart block is common. However, clinical predictors, with reference to current recommendations, could not be identified. Prospective electrophysiologic evaluations may be warranted to establish guidelines for long term pacemaker dependency and criteria for pacing.
Bruckheimer
Elchanan
E
Section of Pediatric Cardiology, Yale University School of Medicine, New Haven, CT, USA.
Berul
Charles I
CI
Kopf
Gary S
GS
Hill
Sharon L
SL
Warner
Kenneth A
KA
Kleinman
Charles S
CS
Rosenfeld
Lynda E
LE
Nehgme
Rodrigo A
RA
D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D006327:Heart Block / Q000209:etiology / Q000628:therapy*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies