Clinical analysis of 73 pediatric patients with completely atrioventricular conduction block

Objective To explore the causes, clinical characteristics and prognosis of children's completely atrioventricular block(CAVB). Methods The clinical data of 73 patients with CAVB were analyzed retrospectively from January 2004 to December 2013 at the Cardiology Department, Nanjing Children's Hospital Affiliated to Nanjing Medical University.Within those 73 patients, 34 patients were male and the others were female, from 3 months old to 12.5 years old, the mean age of 6 years. Results There were 21 congenital CAVB patients and 52 acquired CAVB patients with myocarditis undergoing ventricular septal defect (VSD) closure operation.All congenital CAVB patients were refractory to drug therapy.Electrocardiogram and echocardiogram were performed in 19 cases without clinical symptoms during follow-up, but 2 cases had permanent pacemaker implanted.Among 27 fulminant myocarditis, Adams-Stokes attacks were found in 15 cases, 3 cases had Adams-Stokes attack in 15 cases with sequelae of myocarditis, and 2 out of 6 cases undergoing VSD closure operation had Adams-Stokes attack, and other 4 cases without clinical symptoms were followed up periodically.The acquired CAVB patients were given energy composition and intravenous megavitamin C. The cases with fulminant myocarditis were given adrenal cortical hormone and intravenous gamma globulins simulta-neously.A total of 27 acquired CAVB patients were implanted temporary pacemaker and 5 with permanent pacemaker.Among 52 acquired CAVB patients, 31 cases were cured, 9 cases were improved, 11 cases were ineffective, and 1 case died. Conclusions Most congenital CAVB children without clinical symptoms need clinical follow-ups.Myocarditis is a major cause of acquired CAVB.The CAVB prognosis caused by fulminant myocarditis may be related to antimely implanting the temporary pacemaker timely.Permanent pacemaker should be implanted in patients who have no response to drug therapy with frequent Adams - Stokes or heart failure. Key words: Complete atrioventricular block; Pacemaker; Prognosis; Child