Pacemaker Management and In-Hospital Outcomes in Neonatal Congenital Atrioventricular Block

Matthew F Mikulski; Andrew Well; Daniel Shmorhun; Charles D Fraser Jr; Carlos M Mery; Arnold L Fenrich Jr

doi:10.1016/j.jacep.2023.05.003

Pacemaker Management and In-Hospital Outcomes in Neonatal Congenital Atrioventricular Block

JACC Clin Electrophysiol. 2023 Sep;9(9):1977-1986. doi: 10.1016/j.jacep.2023.05.003. Epub 2023 Jun 21.

Authors

Matthew F Mikulski¹, Andrew Well², Daniel Shmorhun³, Charles D Fraser Jr², Carlos M Mery², Arnold L Fenrich Jr³

Affiliations

¹ Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA. Electronic address: matthew.mikulski@austin.utexas.edu.
² Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
³ Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.

PMID: 37354188
DOI: 10.1016/j.jacep.2023.05.003

Abstract

Background: Neonatal congenital atrioventricular block (nCAVB) is rare, causes bradycardia, confers high mortality, and frequently requires pacing. In-hospital outcomes and pacemaker management in nCAVB are limited.

Objectives: The purpose of this study was to analyze pacing and outcomes of nCAVB with and without congenital heart disease (CHD) using a multicenter database.

Methods: A Pediatric Health Information System database review from January 1, 2004, to June 30, 2022. Patients <31 days of age with a nCAVB International Classification of Diseases-9th/10th Revision diagnosis code and no cardiac surgeries except pacemaker were included. Pacing and in-hospital mortality were analyzed using univariate and multivariable logistic statistics and competing risk and event-free survival models.

Results: Of 1,146 patients with nCAVB, 659 (57.5%) were girls and 506 (44.2%) were premature. Among the 326 (28.4%) with CHD, 134 (41.1%) underwent pacemaker insertion as initial intervention and 56 (17.2%) had temporary pacing wires. In-hospital mortality occurred in 118 (36.2%), with increased adjusted odds with temporary pacing wires placed at 0 to 1 or 2 to 7 days of age relative to no wires, and with decreased odds among pacemakers placed at 2 to 7 or 8+ days of age relative to no pacemaker. Of 820 (71.6%) without CHD, 334 (40.7%) underwent pacemaker insertion as the initial intervention and 81 (9.9%) had temporary pacing wires. In-hospital mortality occurred in 69 (8.4%) with increased adjusted odds in prematurity and decreased odds among pacemaker placement at 2 to 7 days of age relative to no pacemaker.

Conclusions: Over 18.5 years, in-hospital mortality occurred in 36.2% of nCAVB patients with CHD and 8.4% with non-CHD. Associations with increased in-hospital mortality included CHD and prematurity and decreased with pacemaker placement. Prospective registries are needed to better characterize and standardize management of this rare but high-mortality disease.

Keywords: arrhythmia; congenital atrioventricular block; congenital heart disease; outcomes; pacemaker management.

Publication types

Multicenter Study

MeSH terms

Atrioventricular Block*
Bradycardia
Cardiac Pacing, Artificial / adverse effects
Child
Female
Heart Defects, Congenital* / surgery
Humans
Infant, Newborn
Male
Pacemaker, Artificial* / adverse effects
Prospective Studies