Pediatric Cardiology

, Volume 34, Issue 4, pp 999–1005 | Cite as

Pattern of Recovery for Transient Complete Heart Block After Open Heart Surgery for Congenital Heart Disease: Duration Alone Predicts Risk of Late Complete Heart Block

  • Peter F. Aziz
  • Gerald A. Serwer
  • David J. Bradley
  • Martin J. LaPage
  • Jennifer C. Hirsch
  • Edward L. Bove
  • Richard G. Ohye
  • Macdonald DickII
Original Article

Abstract

Transient complete heart block (TCHB) is defined as complete interruption of atrioventricular conduction (AVC) after cardiac surgery followed by return of conduction. This study aimed to assess the risk for the development of late complete heart block (LCHB) after recovery of TCHB and to examine the electrocardiographic and electrophysiologic properties of the AVC system after TCHB. Of the 44 patients in this study who experienced TCHB, 37 recovered completely. Seven patients progressed from TCHB to intermittent CHB or LCHB requiring pacemaker implantation. Preoperative, early postoperative, and late postoperative electrocardiograms as well as postoperative atrial stimulation were obtained. The results showed that the median duration of TCHB was 5 days in the TCHB group compared with 9 days in the LCHB group (p = 0.01). All 37 subjects with TCHB recovered AVC within 12 days, but only two with LCHB did so (p = 0.02). The risk of LCHB for the patients with 7 days of postoperative TCHB or longer was 13 times greater than for the patients with fewer than 7 days of TCHB (p = 0.01). The median late postoperative PR interval was slightly but significantly longer in the LCHB group than in the TCHB group (p = 0.02). In contrast, the electrophysiologic properties between the two groups did not differ significantly. From those findings, we concluded that delayed recovery of AVC after surgical TCHB (≥7 days), but not electrophysiologic properties of recovered AVC assessed early in the postoperative period strongly, predicts risk of LCHB. Follow-up evaluation of AVC is particularly indicated for the delayed recovery group.

Keywords

Congenital heart disease Congenital heart surgery Heart block Pacemakers Pediatrics 

Abbreviations

AHA

American Heart Association

APS

Atrial programmed stimulation

AV

Atrioventricular

AVC

Atrioventricular conduction

AVCERP

Atrioventricular conduction effective refractory period

CHB

Complete heart block

CHD

Congenital heart disease

CI

Confidence intervals

ECG

Electrocardiogram

HRS

Heart Rhythm Society

IQR

Interquartile range

LCHB

Late complete heart block

OR

Odds ratio

RAC

Receiver operating curve

SCHB

Surgical complete heart block

TCHB

Transient complete heart block

WBCL

Wenckebach cycle length

Notes

Acknowledgments

We thank Janet Donohue and Sunkyung Yu and the Michigan Congenital Heart Outcomes Research and Discovery unit for support, consultation, and statistical assistance.

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Peter F. Aziz
    • 1
    • 5
  • Gerald A. Serwer
    • 1
    • 3
  • David J. Bradley
    • 1
    • 3
  • Martin J. LaPage
    • 1
    • 3
  • Jennifer C. Hirsch
    • 2
    • 4
  • Edward L. Bove
    • 2
    • 4
  • Richard G. Ohye
    • 2
    • 4
  • Macdonald DickII
    • 1
    • 3
  1. 1.Division of Pediatric CardiologyC. S. Mott Children’s HospitalAnn ArborUSA
  2. 2.Section of Pediatric Cardiovascular SurgeryC. S. Mott Children’s HospitalAnn ArborUSA
  3. 3.Department of Pediatrics and Communicable DiseaseUniversity of Michigan Medical SchoolAnn ArborUSA
  4. 4.Department of Cardiac SurgeryUniversity of Michigan Medical SchoolAnn ArborUSA
  5. 5.Cleveland ClinicClevelandUSA

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