Comparison of Global Longitudinal Strain in Dual-chamber versus Ventricular Pacemaker in Complete Heart Block.

Context: Bradycardia caused by total atrioventricular block (TAVB) is treated by implantation of permanent pacemakers (PPMs) in either dual-chamber (DDD) versus ventricular (VVI) pacing modes. DDD is considered a more physiological pacing mode than VVI as it avoids atrioventricular dyssynchrony. However, previous trials have failed to demonstrate the superiority of DDD in improving quality of life and morbidity. Aims: This study aims to provide postpacemaker function of the left ventricle (LV) measured with global longitudinal strain (GLS), in TAVB patients. Settings and Design: This is a comparative study; samples included in the study are adult TAVB patients undergoing PPM implantation, without significant heart function, and structural abnormality. Echocardiographic parameters are obtained before, after 1 month, and after 3 months post-PPM. Subjects and Methods: A total of 98 TAVB patients undergoes PPM implantation during the study period, 55 patients were excluded, and in the end, only 43 patients fulfill the inclusion criteria. Statistical Analysis Used: Baseline data between DDD and VVI are compared using unpaired t-test. Statistical significance 1 month post-PPM and 3 months post-PPM is analyzed using paired t-test. Results: There were no significant differences between both groups at baseline. However, significant GLS changes are observed 1 month after PPM in the VVI group (P = 0.002), but no significant change was observed in the DDD group even after 3 months (P = 0.055). Conclusions: In our study, we conclude that DDD is superior in maintaining LV function in the short term in TAVB patients after PPM implantation.

Total atrioventricular block in pregnancy -Case report.

Introduction and importance: Bradycardia in pregnancy due to total atrioventricular block (TAVB) is a rare occurrence, often asymptomatic and may arise from a congenital disorder. Pacemaker is often required. Cases are few and management is not yet standardised. Case presentation: A 24-year-old G2P0A1 of 9 months gestation presented with labor pains. She had had history of bradycardia diagnosed since a year prior but had not undergone tests nor received treatments. Her heart rate was 55-60 x/minute, her cardiotocography was reassuring and electrocardiogram revealed a TAVB with ventricular escape rhythm. As she had not had a pacemaker, an urgent cardiologist consultation was arranged during which a temporary pacemaker was installed. She underwent a caesarean section with general anaesthesia after which she had an uneventful recovery.A 38-year-old G2P1A0 of 2 months of gestation presented with slow heart rhythm and a history of asthma to the outpatient clinic. She also had not undergone tests nor received medication. At presentation, her heart rate was 48 x/minute and her ECG revealed a TAVB with junctional escape rhythm. She had a pacemaker installed at 8 months of gestation and subsequently underwent an elective caesarean section at 37 weeks under regional anaesthesia. She had an uneventful recovery afterwards. Clinical discussion: TAVB in pregnancy requires a concerted effort involving obstetricians, cardiologists, and intensivists. Pacemaker implantation is recommended. Whilst vaginal delivery remains first-choice, caesarean section is indicated under obstetric indications. Conclusion: Screening, early recognition, risk stratification and thorough planning are required to successfully manage TAVB in pregnancy.

Bloqueio atrioventricular total pós- correção cirúrgica de defeito do septo atrioventricular parcial em paciente com associação charge / Total atrioventricular block after septum defect correction surgery partial atrioventricular in patients with charge association / Bloqueo aurículoventricular total post-corrección quirúrgica de defecto del septo aurículoventricular parcial en paciente con asociación charge

Descreveremos o caso de uma paciente com uma síndrome rara (Associação Charge), que evoluiu para uma complicação bastante temida, o bloqueio atrioventricular total, no pós-operatório de correção do defeito do septo atrioventricular parcial.

We will describe a woman’s case with a rare syndrome (Charge Association) with a quite feared complication evolution, the total atrioventricular block, in the postoperative of partialatrioventricular defect correction.

Describiremos el caso de una paciente con un síndrome raro (Asociación Charge), que evolucionó hacia una complicación bastante temida, el bloqueo aurículoventricular total, en el postoperatorio de corrección del defecto del septo aurículoventricular parcial.