Late Outcome and Predictors of Adverse Events Related to the Implantation of a Permanent Pacemaker in Patients with Isolated Congenital Atrioventricular Block.

Abstract

Isolated congenital atrioventricular block (ICAVB) is a rare, and pacemaker implantation is the only effective treatment. We sought to identify the predictive factors of adverse events related to pacemaker implantation in ICAVB. This is a cohort study of patients diagnosed with ICAVB who underwent pacemaker implantation from 1980 to 2014 in a single center. During the studied period, a total of 647 patients underwent implantation of their first permanent cardiac pacemaker before 30years of age. Of these, only 62 (9.5%) were diagnosed with ICAVB. This condition was diagnosed in utero in 15 (24.2%) cases, 5 (8.1%) in the neonatal period, 32 (51.6%) during childhood, and 10 (16.1%) during adolescence and young adulthood. The presence of autoantibodies (anti-Ro/SSA) was observed in 41% of mothers who underwent serological evaluation. Age at the time of the initial pacemaker implant was 9.8±9years. During a mean follow-up time of 15years, 1 (1.7%) death occurred due to infectious endocarditis. Complications related to pacemaker implant were reported in 24 patients (38.7%). The number of complications was significantly higher in the group with an epimyocardial implantation site (HR 6; CI 2.45-14.95). Ventricular dysfunction occurred in 6 (11.7%) patients; however, we were not able to identify any predictors of it. Our results showed a low mortality rate after permanent therapy. However, these patients exhibited high morbidity related to the pacemaker system, and the epimyocardial implant site was an independent predictor of complications. Predictors of left ventricular dysfunction were not found in the present study.