Incidence of and Risk Factors for Catheterization-Induced Complete Heart Block in the Pediatric Cardiac Catheterization Laboratory

Abstract

Background-The majority of the literature on catheterization-induced heart block (CIHB) was published >30 years ago.The field of cardiac catheterization has evolved, performing more interventional compared with diagnostic cases. We sought to determine the incidence and risk factors of CIHB. Methods and Results-A catheterization database that records the occurrence of adverse events on all cases was queried for heart block. Additional retrospective data on event outcome were collected on patients who developed CIHB. Multivariable logistic regression modeling was used to identify risk factors of CIHB (odds ratio, 95% confidence interval). In a 6-year period, 6183 cases were performed. The median weight was 15.0 (7.0-47.0) kg, with 29% consisting of infants <1 year. A total of 72% involved complex congenital heart disease. One hundred thirty-five cases were complicated by CIHB (2.2%; 95% confidence interval, 1.9-2.6). Age <1 year (3.0; 2.2-4.3) and case duration ≥2 hours (3.4; 2.0-6.0) were risk factors of CIHB; cardiac anatomy and intervention performed were not. A total of 96% of CIHB recovered within 1 week but 6 patients underwent pacemaker placement (3 L-loop ventricles, 2 intracardiac devices, 1 double inlet-double outlet RV). Of these, 50% recovered atrioventricular nodal conduction within 1 month; 2 patients with L-loop ventricles and 1 patient with a left ventricular-to-right atrial device did not recover. Conclusions-The incidence of CIHB in the pediatric cardiac catheterization laboratory is low at 2.2%. Risk factors include young age and long case duration. The recovery of atrioventricular nodal function after CIHB is high and follows a similar time course to that of postsurgical heart block. (Circ Arrhythm Electrophysiol. 2014;7:127-133.)

A Review of Surgical Atrioventricular Block with Emphasis in Patients with Single Ventricle Physiology

“…Parallels to Catheter Induced AV Block Within the cardiac catheterization literature there are limited studies and case reports dealing with catheter induced AV block. 8,12,13 Although the etiology of block in this circumstance may not be identical to that of surgical block, similarities exist. Data have shown "younger age" and longer case length to be independent risk factors for the development of catheter induced AV block.…”

Stenting and overdilating small Gore‐Tex vascular grafts in complex congenital heart disease

“…In the subgroup of univentricular (precavopulmonary shunt) patient interventions, the incidence of atrioventricular block requiring intervention was 15.0%. In a previous study exploring catheterization‐induced complete heart block in pediatric “all‐comers” , there were 15 precavopulmonary shunt univentricular patients with preintervention mixed venous saturations <60%, of whom, 73% developed procedural complete heart block (in one, this occurred simply during wire placement within the graft). Given that the precavopulmonary shunt patients in this study had a median mixed venous saturation of 56%, the incidence of atrioventricular block was in fact, lower than could have been anticipated.…”

Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance

“…This arrangement is classically seen in cases with the combination of atrial isomerism, an atrioventricular septal defect, and ccTGA. Perioperative AV block may occur with either physiologic or anatomic correction,17 and transient AV block may also be induced by cardiac catheterization 18…”

“…Perioperative AV block may occur with either physiologic or anatomic correction, 17 and transient AV block may also be induced by cardiac catheterization. 18…”