Therapy and outcome of infectious complete atrioventricular block in children

From 1983 to 1997, we have studied ten children with complete atrioventricu lar block likely due to myocarditis in order to assess its prognosis and to define a therapeutic strategy. Their age ranged from 6 days to 16 years (median: 4.1 years). All were admi tted for sudden complete block, with symptoms in seven: syncope or fainting , seizures, collapse. Three had an asymptomatic bradycardia which was detec ted on routine auscultation in children with fever or already hospitalized; fever was present in 5. The disease was related to infection on biological data in 4 cases (1 listeriosis and 3 seroconversions for Epstein Barr or c ytomegalic or Coxsackie B viruses), on a myocardial biposy in 1 case and on scintigraphic data in 1 case. In the remaining 4, indirect arguments were considered such as infectious context, normal recent ECG, favourable outcom e. five children were given intravenous isoprenalin with ventricular tachyc ardia in 3. Five were treated with steroids and 3 with specific antiviral a gents. Seven patients were paced temporarily. One child died, 6 recovered t otally and 3 have a permanent block with a definitive pacemaker implanted i n 2. In conclusion, sudden acquired complete atrioventricular blocks are often i ll-tolerated in children and have to be treated with transient pacing. Reco very occurs as a rule but some of these blocks may be definitive. Infective myocarditis is likely to be the cause of the disease even if the pathogen agent cannot always be identified.