Author + information
- Jason J. Payne,
- Aisha Siraj,
- Fuad Habash and
- Waddah Maskoun
Background: Complete Heart Block (CHB) is uncommon in pregnancy and challenging to manage due to risks of radiation to the fetus.
Methods: A 27-year-old with known 1st degree AV block at 11 weeks gestational age presents with a 5-week history of fatigue, dizziness, and severe dyspnea. BP was 110/60, heart rate was 44 and cardiovascular exam was otherwise normal. She underwent a treadmill ECG and Holter, both revealing symptomatic episodes of CHB. Electrolytes, thyroid function and Echocardiogram were normal. We recommended a dual chamber pacemaker (DCPM). To minimize fluoroscopy, a coronary sinus (CS) catheter was placed as a reference and another catheter was used to build geometry of the CS, right atrium, right ventricle, and the His area. We used US to puncture the axillary vein. The leads were connected to the NavX mapping system, using an alligator clip attached to the pace sense part, and were positioned using 3D mapping. Final fluoroscopy confirmed lead slack and adequate helix extension for less than 10s of fluoroscopy time and less than 1mGy radiation. There were no complications.
Results: Her symptoms resolved. She had an uncomplicated pregnancy and delivery.
Conclusion: CHB is unusual in pregnancy and may be related to pregnancy or become manifest during pregnancy. Management may be expectant, temporary PM at delivery or permanent PM. DCPM can be successfully implanted during pregnancy using TEE which may be less desirable or 3D mapping and has not been widely reported. We present one option for management
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 3
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1188-079
- 2017 American College of Cardiology Foundation