Pacing in a Woman with Full Term Pregnancy: First Case Report in Bangladesh

Abstract

Introduction:Congenital complete atrioventricular block (CCAVB) is a relatively rare and potentially serious problem in pregnancy. 1 There have been relatively few reports of complete heart block in pregnancy. Obstetric experience in women who had pacemakers implanted before conception has been reported, 2 but there is a paucity of information on the management of complete heart block detected for the first time during pregnancy or labour. The patients of CCAVB with pregnancy create a special category because of the inherent risk associated with stress of normal vaginal delivery or cesarean section. Labour in these patients may be complicated by syncope and convulsions caused by slowing of the heart rate during the Valsalva maneuver exercised at the time of forceful contractions of the second stage of labour. 3 Moreover a pregnant woman cannot readily undergo permanent pacemaker implantation because of the radiation hazard involved with fluoroscopic procedure. We are reporting a case of CCAVB with full term pregnancy that has been managed by the coordinated action of cardiologist and obstetrician of two separate hospitals. Case Report:A 19-year-old lady (Fig.1), hailing from Madaripur, presented with complaints of occasional palpitation and full term pregnancy. She had a history of sudden fall on the ground 4 years back at school. She also experienced a syncopal attack 3 years ago while taking bath in a pond. Her antenatal period was uneventful. An ECG was done as part of her pre-operative assessment (for cesarean section) and it showed complete heart block with ventricular rate 43 beats/ min. (Fig.2). The patient did not have history of taking any beta-blocker, calcium-channel blocker or digitalis. She was referred to National Institute of Cardiovascular Diseases (NICVD). On examination her pulse rate was 38 beats/ minute, regular and blood pressure was 110/60mm Hg. Mild pallor was present. Otherwise her general, physical and cardiovascular examinations were unremarkable. On abdominal examination, there was a single foetus in cephalic presentation and uterine height corresponded to 36 weeks of gestation. There were mild uterine contractions