To define the long-term natural history of congenital complete heart block, we followed 27 patients prospectively by means of frequent ambulatory electrocardiographic (ECG) recordings for a mean (+/- SD) of 8 +/- 3 years. During that time, 8 of the 13 patients with a mean daytime heart rate below 50 bpm (Group A) had cardiac complications such as sudden death, syncope, presyncope, or excessive fatigue. Six of the eight patients had additional ECG findings that suggested an instability of the junctional escape mechanism. These findings included nocturnal junctional exit block (three patients), little or no change in the junctional rate with physical activity (three patients), and associated tachyarrhythmias (three patients). None of the 14 patients with a mean daytime heart rate of 50 bpm or more (Group B) had an adverse clinical outcome, and 5 of the 13 patients in Group A also remained well. Among the five patients in stable condition in Group A, three had no evidence of an unstable junctional mechanism. We conclude that patients with a mean daytime junctional rate below 50 bpm and other evidence of an unstable junctional escape mechanism should probably undergo prophylactic pacemaker implantation. Since junctional exit block and tachyarrhythmias sometimes appear first during follow-up, the method of risk stratification employed in this study depends on serial ambulatory ECG recordings.
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[Full Text]
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[Full Text]
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(2007). Guidelines for cardiac pacing and cardiac resynchronization therapy: The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology. Developed in Collaboration with the European Heart Rhythm Association. Eur Heart J
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[Full Text]
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(2007). Age-related role of ambulatory electrocardiographic monitoring in risk stratification of patients with complete congenital atrioventricular block. Europace
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(2003). Proposal for a new definition of congenital complete atrioventricular block. Lupus
12: 427-435
[Abstract]
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(2002). ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines) . J Am Coll Cardiol
40: 1703-1719
[Full Text]
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(2002). ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation
106: 2145-2161
[Full Text]
Balmer, C., Fasnacht, M., Rahn, M., Molinari, L., Bauersfeld, U.
(2002). Long-term follow up of children with congenital complete atrioventricular block and the impact of pacemaker therapy. Europace
4: 345-349
[Abstract]
Crawford, M. H., Bernstein, S. J., Deedwania, P. C., DiMarco, J. P., Ferrick, K. J., Garson, A. Jr, Green, L. A., Greene, H. L., Silka, M. J., Stone, P. H., Tracy, C. M., Gibbons, R. J., Alpert, J. S., Eagle, K. A., Gardner, T. J., Garson, A. Jr, Gregoratos, G., Russell, R. O., Ryan, T. J., Smith, S. C. Jr
(1999). ACC/AHA guidelines for ambulatory electrocardiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the Guidelines for Ambulatory Electrocardiography) developed in collaboration with the North American Society for Pacing and Electrophysiology. J Am Coll Cardiol
34: 912-948
[Full Text]
Friedman, R. A.
(1995). Congenital AV Block : Pace Me Now or Pace Me Later?. Circulation
92: 283-285
[Full Text]
Michaelsson, M., Jonzon, A., Riesenfeld, T.
(1995). Isolated Congenital Complete Atrioventricular Block in Adult Life : A Prospective Study. Circulation
92: 442-449
[Abstract][Full Text]
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