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Outcome of, and risk factors for, second degree atrioventricular block in children

Published online by Cambridge University Press:  19 August 2008

Elizabeth Villain ,
Damien Bonnet ,
Conceicão Trigo ,
Laurence Iserin ,
Daniel Sidi  and
Jean Kachaner
Elizabeth Villain*
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
Damien Bonnet
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
Conceicão Trigo
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
Laurence Iserin
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
Daniel Sidi
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
Jean Kachaner
Affiliation:
From the Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-Malades, Paris
*
Dr. Elizabeth Villain, Service de Cardiologie Pédiatrique, Hôpital Necker/Enfants-malades, 149 Rue de Sévres, 75743 Paris cedex 15, France. Tel. 1 44 49 43 51; Fax. 1 44 49 43 40.
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Abstract

Second degree atrioventricular block is uncommon in children. In order to evaluate its outcome, and to find early prognostic factors, we reviewed the history and evolution of 21 children with this arrhythmia discovered on their surface electrocardiogram. Twenty-four-hour monitoring displayed variations in the conduction patterns in almost all children, from long PR interval to complete heart block alternating in the same patient. At follow-up (nine months to 19 years), 13 children (62%) had received implantation of a pacemaker because of progression either to complete atrioventricular block or to severe ventricular bradycardia. Atrioventricular conduction improved on exercise in 11 children, but this did not predict a favorable outcome since four of them required pacing. In contrast, deterioration during sinus acceleration in four patients predicted further aggravation. A supra-Hisian location of the block did not protect against the occurrence of syncope in the two patients who underwent His recordings. Finally, the outcome was not linked to age at diagnosis. Second degree atrioventricular block, therefore, should be considered a serious disease because of its trend to worsen towards complete block and/or severe complications. Close follow-up, including repeated 24-hour monitoring, is the most effective way to unmask such a progression and to avoid its clinical consequences.

Keywords

Congenital heart blocksecond degreebradycardiapacemaker
Type
Original Manuscripts
Information
Cardiology in the Young , Volume 6 , Issue 4 , October 1996 , pp. 315 - 319
Copyright
Copyright © Cambridge University Press 1996

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