Pediatric Heart Block is Congenital - What do the Doctors have to say about it? - Dr Manoj Daga

Written by Dr Manoj Daga Published On 2023-11-02T15:50:27+05:30 | Updated On 2 Nov 2023 3:50 PM IST

Pediatric Heart Block is Congenital - What do the Doctors have to say about it? - Dr Manoj Daga

Complete heart block in children is one of the rare conditions. But first, it's crucial to comprehend the fundamentals of a healthy heart. The muscle contains an electrical circuit with a primary generator called the SA node and a secondary generator called the AV node.

Therefore, in a typical situation, an impulse is created in the SA node, travels to the AV node, and then disperses across the entire heart. This impulse's entire purpose is to stimulate the heart and cause it to contract, which is what the heart needs to do to pump blood. In a typical child, the heart beats and contracts at a rate of about 100 beats per minute, maintaining the flow of blood throughout the body.

One of the extremely rare disorders in infants is complete heart block, which can present after birth. Isolated cases do not have an underlying cause behind it. However, it can occur in mothers suffering from SLE, a rare disease that causes joint discomfort, rash, and fever and it can lead to autonomic reaction to conduction system while it is still developing and growing in the mother's womb.

More commonly it results as a complication after cardiac surgery, when the conduction system is somehow harmed during the procedure. When a child is suspected of a very slow heart rate, a simple test called 12 lead ECG helps to diagnose the condition. Heart block can be a part of other complex congenital heart diseases, the most common one is called corrected transposition, and an echocardiography is always needed to rule out the possibility of the child having any underlying congenital complex heart condition.

A child with a complete heart block will have an extremely slow heart rate when they are evaluated, and at first there may not be any other symptoms. The impulses produced in the primary generator, the SA node, are not being routed to the second regenerator, the AV node. As a result, the SA node is cut off, leaving the child with the AV node rhythm, which is an escape rhythm and is between 50 and 60 beats per minute.

There are certain specific guidelines on how to manage this sort of condition in children. Most importantly even with slow heart rate, a lot of babies and children can manage because they are not highly active. So if a child is well feeding and growing without any symptoms they can be closely monitored.

Symptoms to look for are blackouts or feeding difficulties or gets tired or poor growth and there remains a risk of sudden death. we tend to do a 24-hour holter monitoring as an evaluation of average heart rate. If a child is symptomatic and the average heart rate is very slow, then the only treatment for such conditions is called implantation of pacemaker.

They are often placed in the abdominal wall, and a wire from this pacemaker is attached to the heart which instructs it to beat as needed. Most of these patients will need a permanent pacemaker. As the child develops, a different pacemaker will be used, called a trans venous pacemaker, which is generally used in adults to restore normal heart activity.

People have a misconception about life with a pacemaker. Can a child lead a normal life with a pacemaker. But for information, pacemaker will significantly improve the child's quality of life, decrease the risk of sudden death. The child will be significantly benefited from it because it will tune the heart appropriately and beat in accordance with the child's requirements.

For example, when the child is playing, the pacemaker will meet all the requirements and it will assist the child to deal with physical activities and play games.Thus, there is no need for concern and it is very safe. When a child has a pacemaker, the only issue is that the batteries need to be replaced after every eight to ten years, which requires minor surgery. In light of this uncommon complete heart block situation, a permanent treatment persists.

Disclaimer: The views expressed in this article are of the author and not of Medical Dialogues. The Editorial/Content team of Medical Dialogues has not contributed to the writing/editing/packaging of this article.

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Dr Manoj Daga

Dr Manoj Daga MBBS, MS (General Surgery), MCh (Cardiothoracic and Vascular Surgery) is the Director of Cardiothoracic and Vascular Surgery (CTVS) at BM Birla Heart Research Centre, Kolkata, West Bengal having overall experience of more than 23 years in Cardiothoracic and Vascular Surgery. His area of interest lies in Adult and Paediatric Heart Surgery for Congenital Heart Diseases with a special interest in Coronary Aortic Root Surgery and Heart And Lung Transplant.