Congenital complete atrioventricular block is a rare cardiac conduction disorder where atrial impulses fail to conduct to the ventricles, resulting in asynchronous atrial and ventricular activation. This asynchrony often leads to severe bradycardia, frequently necessitating cardiac pacing, and is associated with significant morbidity and mortality both in utero and postnatally. We present a case of a preterm twin born at 34 weeks of gestation, with a birth weight of 1.5 kg, diagnosed with congenital complete atrioventricular block during pregnancy. Following birth, due to severe bradycardia of 40 bpm, the infant was initially managed with continuous isoproterenol infusion. Oral salbutamol was subsequently introduced, allowing for a gradual tapering off isoproterenol. The side effect of increased heart rate associated with salbutamol allowed the infant to maintain a heart rate above 70 bpm. Over the first 4 months of life, the infant demonstrated normal growth and development, reaching a weight of 4 kg. At 4 months, after experiencing feeding difficulties, a pacemaker was implanted. This therapeutic strategy allowed for the postponement of pacemaker implantation through noninvasive management with oral salbutamol, reducing the risks of prolonged central line use and repeated pacemaker implantation.
Elron et al. (Thu,) studied this question.