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Do Patients with Asymptomatic Congenital Complete Heart Block Require a Pacemaker for Non-Cardiac Surgery?

DOI: 10.4236/ojanes.2018.84014, PP. 130-135

Keywords: Congenital Complete Heart Block, Pacemaker, Non-Cardiac Surgery

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Abstract:

The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.

References

[1]  Bordachar, P., Whinnett, Z., Ploux, S., Labrousse, L., Haissaguerre, M. and Thambo, J.B. (2013) Pathophysiology, Clinical Course, and Management of Congenital Complete Atrioventricular Block. Heart Rhythm, 10, 760-766.
https://doi.org/10.1016/j.hrthm.2012.12.030
[2]  Dolara, A. and Favilli, S. (2010) Controversies in the Therapy of Isolated Congenital Complete Heart Block. Journal of Cardiovascular Medicine, 11, 426-430.
https://doi.org/10.2459/JCM.0b013e3283397801
[3]  Csontos, C.S., Bogar, L. and Melczer, L. (2003) Temporary Pacemakers for Non-Cardiac Surgery. European Journal of Anaesthesiology, 20, 581-582.
https://doi.org/10.1097/00003643-200307000-00014
[4]  Freedman, R.A., Swerdlow, C.D., Echt, D.S., Winkle, R.A., Soderholm-Difatte, V. and Mason, J. (1984) Facilitation of Ventricular Tachyarrythmia Induction by Isoproterenol. American Journal of Cardiology, 54, 765-770.
https://doi.org/10.1016/S0002-9149(84)80205-2
[5]  Tracy, C.M., Epstein, A.E. Darbar, D., et al. (2013) 2012 ACCF/AHA/HRS Focused Update Incorporated into the ACCF/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities. Journal of the American College of Cardiology, 61, e6-e75.
https://doi.org/10.1016/j.jacc.2012.11.007
[6]  Diaz, J.H. and Friesen, R.H. (1979) Anesthetic Management of Congenital Complete Heart Block in Childhood. Anesthesia & Analgesia, 58, 334-336.
[7]  Brubaker, P.H. and Kitzman, D.W. (2011) Chronotropic Incompetence: Causes, Consequences, and Management. Circulation, 123, 1010-1020.
https://doi.org/10.1161/CIRCULATIONAHA.110.940577
[8]  Linton, D.M. and Human, D.G. (1984) Peri-Operative Management and Administration of Anaesthesia in Children with Congenital Complete Heart Block. South African Medical Journal, 66, 875-876.
[9]  Mohan, V.K., Naik, A.K., Bharti, N. and Shende, D. (2003) A Patient with Congenital Complete Heart Block Undergoing Multiple Exposures to General Anesthesia. Anaesthesia and Intensive Care, 31, 667-671.
[10]  Sundararaman, L., Cohn, J.H. and Ranasinghe, J.S. (2016) Complete Heart Block in Pregnancy: Case Report, Analysis, and Review of Anesthetic Management. Journal of Clinical Anesthesia, 33, 58-61.
https://doi.org/10.1016/j.jclinane.2016.01.021
[11]  Herman, S.C. and Zhou, J. (2011) Isoproterenol Infusion for Treatment of Refractory Symptomatic Bradycardia in Parturients with Congenital Complete Heart Block. International Journal of Obstetric Anesthesia, 20, 361-363.
https://doi.org/10.1016/j.ijoa.2011.05.003
[12]  DeSimone, C.A., Leighton, B.L., Norris, M.C., Chayen, B. and Menduke, H. (1988) The Chronotropic Effect of Isoproterenol Is Reduced in Term Pregnant Women. Anesthesiology, 69, 626-628.
https://doi.org/10.1097/00000542-198810000-00034
[13]  Gupta, K., Balachander, H., Badhe, A. and Mohan, R.M. (2010) Low-Dose Spinal Anesthesia in Asymptomatic Complete Heart Block without Perioperative Pacing. Journal of Anesthesia, 24, 660-661.
https://doi.org/10.1007/s00540-010-0938-x
[14]  Kelly, J.S. and Royster, R.L. (1989) Noninvasive Transcutaneous Cardiac Pacing. Anesthesia & Analgesia, 69, 229-238.
https://doi.org/10.1213/00000539-198908000-00016
[15]  O’Gara, J.P. and Edelman, J.D. (1981) Anesthesia and the Patient with Complete Congenital Heart Block. Anesthesia & Analgesia, 60, 906-908.

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