Paroxysmal atrioventricular block in young patients.
We describe 17 patients (8 girls, and 9 boys), aged 9.6 +/- 5.7 years, with paroxysmal atrioventricular block (PAVB), a condition rarely described in children. Holter monitoring documented the PAVB in 15 patients, and tilt test was performed in 4 patients (positive in 1). The electrocardiograph (ECG) was normal in 7 patients. Two patients had acquired and 11 patients had congenital heart disease (CHD). Syncope or presyncope were present in 7 patients. A normal ECG was significantly more frequent in symptomatic patients. Pauses were significantly longer in girls and in children <5 years. PAVB was recorded only during nocturnal hours in 6 patients and throughout the day in the others. The sinus rate decreased during PAVB in 6 patients and increased in 4 (generally younger girls with symptoms). Permanent pacemakers were implanted in 13 patients, including 7 asymptomatic patients with CHD and severe bradycardia. During follow-up (3.7 +/- 2.5 years), 1 patient developed complete AVB. Although PAVB was still present in 91% of paced patients, symptoms did not recur because pacing prevented the pauses. In conclusion, PAVB is a rare arrhythmia. Autonomic nervous system dysfunction seems to play an etiological role and permanent pacing was an effective treatment.
Silvetti
M S
MS
Cardiac Arrhythmias Service, Cardiology and Heart Surgery Department, Bambino Gesù Pediatric Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy. silvetti@opbg.net
Grutter
G
G
Di Ciommo
V
V
Drago
F
F
D000293:Adolescent; D000328:Adult; D002304:Cardiac Pacing, Artificial; D002648:Child; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012189:Retrospective Studies