ABSTRACT
Paroxysmal atrioventricular block (PAVB) is rare in children. A 1-year-old boy presented with PAVB and sinus arrest that resulted in refractory life-threatening symptomatic long pauses. Continuous heart rate variability analysis with high time resolution (wavelet analysis) revealed an abrupt increase in parasympathetic activity just before a long pause, which indicated a vagal reflex. Although a pacemaker is not always effective because of a concomitant vasodepressive response in such cases, the complete stabilization after pacemaker implantation in this case supports the necessity and usefulness of pacemaker implantation in patients with reflex-induced highly symptomatic bradycardia.
Subject(s)
Atrioventricular Block/complications , Atrioventricular Block/prevention & control , Cardiac Pacing, Artificial/methods , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/prevention & control , Atrioventricular Block/diagnosis , Electrocardiography/methods , Humans , Infant , Male , Sinus Arrest, Cardiac/complications , Treatment OutcomeABSTRACT
In this case, a patient who is incapable of participating in health-care decisions requires a pacemaker generator replacement. Because the pacemaker may no longer be necessary, the issues of surrogacy and surrogate decision-making are considered. Where there are no involved family members, each state has procedures for finding an appropriate ombudsman for the patient who can assist in healthcare choices.
