title: Pattern of recovery for transient complete heart block after open heart surgery for congenital heart disease: duration alone predicts risk of late complete heart block.
abstract: Transient complete heart block (TCHB) is defined as complete interruption of atrioventricular conduction (AVC) after cardiac surgery followed by return of conduction. This study aimed to assess the risk for the development of late complete heart block (LCHB) after recovery of TCHB and to examine the electrocardiographic and electrophysiologic properties of the AVC system after TCHB. Of the 44 patients in this study who experienced TCHB, 37 recovered completely. Seven patients progressed from TCHB to intermittent CHB or LCHB requiring pacemaker implantation. Preoperative, early postoperative, and late postoperative electrocardiograms as well as postoperative atrial stimulation were obtained. The results showed that the median duration of TCHB was 5 days in the TCHB group compared with 9 days in the LCHB group (p = 0.01). All 37 subjects with TCHB recovered AVC within 12 days, but only two with LCHB did so (p = 0.02). The risk of LCHB for the patients with 7 days of postoperative TCHB or longer was 13 times greater than for the patients with fewer than 7 days of TCHB (p = 0.01). The median late postoperative PR interval was slightly but significantly longer in the LCHB group than in the TCHB group (p = 0.02). In contrast, the electrophysiologic properties between the two groups did not differ significantly. From those findings, we concluded that delayed recovery of AVC after surgical TCHB (≥7 days), but not electrophysiologic properties of recovered AVC assessed early in the postoperative period strongly, predicts risk of LCHB. Follow-up evaluation of AVC is particularly indicated for the delayed recovery group.
authors.affiliation: Division of Pediatric Cardiology, C. S. Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109-5204, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Aziz
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Serwer
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Martin J
authors.initials: MJ
authors.lastname: LaPage
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hirsch
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ohye
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
mesh_terms: D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000503:physiopathology* / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications / Q000503:physiopathology* / Q000601:surgery*; D012372:ROC Curve; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D016896:Treatment Outcome