Transesophageal Echocardiography for Insertion of a Physiological Pacemaker in Early Pregnancy

Abstract

A dual chamber pacemaker was implanted during the first trimester of pregnancy in a patient with second-degree heart block and syncope. Transesophageal echocardiography was used to confirm satisfactory position in the right atrial appendage.

Implantation of a permanent pacemaker in a pregnant woman under the guidance of electrophysiologic signals and transthoracic echocardiography

“…Very few reports on the safety and reliability of echocardiographic guidance for the implantation of permanent pacemakers are available in the literature [2][3][4][5]. Moreover, there are no published experiences regarding the 'hybrid' approach.…”

“…In the same study, sinus bradycardia was present in 1% of women, whereas only a few cases of sinus node dysfunction requiring pacemaker implantation during pregnancy have been reported in the literature [2][3][4][5]. Pacemakers do not interfere with the normal course of pregnancy; therefore, pacemaker implantation should be considered in patients with heart block who wish to become pregnant [6][7][8].…”

Bradyarrhythmias in pregnancy: a case report and review of management

“…A protective lead shield covering the gravid uterus can be used, 25 or it may be possible to avoid irradiation by using ECG or echocardiographic guidance for pacemaker insertion. [27][28][29] Several reports have documented successful pregnancy and delivery of women with standard ventricular demand permanent pacemakers. 18,27,30 The use of ventilation-sensing, rate responsive pacing in pregnant women with symptomatic heart block has also been advocated.…”

18. Arritmias cardíacas e parada cardiorrespiratória na gestação

“…As portadoras de bloqueio A-V de segundo grau tipo II, de bloqueio A-V total e que necessitam receber implante de marca-passo artificial poderão recebê-lo, desde que durante o procedimento se proteja o abdome e o dorso com avental de chumbo 14,15 . É sugerido o uso da ecocardiografia transesofágica para inserção do eletrodo de marca-passo, a fim de reduzir a radiação sobre o concepto 16 . Gestantes que portam marca-passo artificial deverão ser submetidas ao controle do aparelho, da mesma forma que as não gestantes 17 .…”