Heart Block

Heart Block

J. Peter Harris, MD , Svetlana Tisma-Dupanovic, MD

Basic Information

Definition

Complete heart block (CHB) is a bradycardic rhythm caused by failure of impulse conduction from the atria to the ventricles with complete atrioventricular dissociation. The atrial rate is usually higher than the ventricular rate.

Synonyms

Complete atrioventricular block
Third-degree atrioventricular block
Unless bradycardia is concurrent, atrioventricular dissociation is not an acceptable synonym because this entity may exist with normal rates of at least one pacemaker (e.g., sinus bradycardia with an appropriate junctional rate) and with ventricular tachycardias.

ICD-9-CM Code

746.86 Congenital heart block

Epidemiology & Demographics

• Congenital CHB occurs in 1 in 15,000 to 1 in 25,000 births.
• The mortality of congenital CHB in utero is high if hydrops is present and in premature infants.
• The incidence of surgically induced CHB has progressively decreased and is currently quite low (less than 5%), seen most commonly in the setting of complex cardiac malformation repairs.
• The incidence of CHB in systemic disease and infection is very low.
• Atrioventricular nodal mesotheliomas, extremely rare cardiac tumors, may cause CHB.
• Congenital CHB caused by fetal exposure to anti-Ro (SSA/Ro) and anti-La (SSB/La) occurs in only 1% to 5% of mothers with collagen vascular disease, but the recurrence rate for subsequent pregnancies is 20%.
• No gender predilection is seen with congenital or acquired CHB.

Clinical Presentation

History

• Fetal bradycardia
• Fetal hydrops/intrauterine death
• Congestive heart failure
• Fatigue
• Diminished exercise capacity
• Syncope
• Sudden death
• History of associated malformations or history of systemic illnesses (listed under “Etiology”)

Physical Examination

• Bradycardia but usually regular rhythm

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Jul 2, 2016 | Posted by in PEDIATRICS | Comments Off on Heart Block

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