Heart Block in Unpalliated Complex Adult Congenital Heart Disease: Massive Collateral Burden Precludes Epicardial Pacemaker

Joshua R Hirsch; Christopher R Broda; Peter R Ermis; Wilson W Lam; Angeline D Opina

doi:10.1016/j.jaccas.2020.10.019

Heart Block in Unpalliated Complex Adult Congenital Heart Disease: Massive Collateral Burden Precludes Epicardial Pacemaker

JACC Case Rep. 2021 Jan 6;3(2):192-193. doi: 10.1016/j.jaccas.2020.10.019. eCollection 2021 Feb.

Authors

Joshua R Hirsch¹, Christopher R Broda², Peter R Ermis², Wilson W Lam^{1

2

3}, Angeline D Opina²

Affiliations

¹ Department of Internal Medicine, Baylor College of Medicine, Houston, Texas, USA.
² Department of Pediatrics, Section of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
³ Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, Texas, USA.

Abstract

Complete heart block is a common complication for adults with congenital heart disease (CHD). Epicardial pacing is preferred in patients with septal shunting due to risk of thromboembolism. Anatomic changes in complex CHD may preclude surgical epicardial lead placement. Thromboembolism risk reduction in such patients requiring endocardial pacing remains questionable. (Level of Difficulty: Advanced.).

Keywords: AV, atrioventricular; CHD, congenital heart disease; CT, computed tomography; bradycardia; cardiac pacemaker; computed tomography; cyanotic heart disease; stroke; ventricular septal defect.