1. The Atrioventricular Block in pediatric cardiology Coordinator: Dr. GOZAR LILIANA Author: BENTZ OANA

2.  AVB = atrioventricular block  ECG = electrocardiogram  ASD = arterial septal defect  TGA = transposition of the great arterias  VSD = ventricular septal defect  CHD = congenital heart defect Legend

3. Objectives Objectives I. Introduction II. Material and methods III. Results IV. Discussions V. Conclusions

4.  AV block refers to a conduction delay or interruption of the impulses generated in the atrium before they reach the ventricles. AV block may be transient or permanent. I. Introduction

6. Classification of AVB  congenital AVB  post-surgery AVB

7. Patients in the study have received: Clinical examination Laboratory investigations: History ECG Fetal echocardiography Holter

8. Laboratory investigations: EchocardiographyExercise tolerance test

9.  Treatment for AVB II and III degree temporary (pacing) temporary (pacing) permanent (permanent pacemaker). permanent (permanent pacemaker).

10. Permanent pacing is definitely useful and necessary Permanent pacing may be indicated Class II A option is in favor of efficacy Class II B in which efficacy is less well established Permanent pacing is not useful it can be harm full Classes of pacemaker I II III

11. at infants and children: pacemaker with epicardial electrodes

12. Aim of the work  The goal is to analyze retrospective and prospective major disorders of driving from etiological point of view, therapeutic, evolutionarily.

13. II. Material and methods  The study group: 91 children average: age of 5 years and 5 months (between 2 days and 18 years) average: age of 5 years and 5 months (between 2 days and 18 years) period: 2008-2013 period: 2008-2013 The II Cardiology Clinic of children in Tg. Mures The II Cardiology Clinic of children in Tg. Mures Type of study: Type of study: prospective retrospective 2008 - 2012 and 2013

14.  We had 17 cases (18.68%) of congenital AVB II and III degree; 74 cases (81.32%) of post-surgery AVB II and III degree.  Congenital AVB may become manifest in:  The clinical suggestive element is reduced heart rate. intrauterine (2 cases)newborn period (9 cases) early childhood (2 cases)

15. using Chi-square test (Pearson), we obtained results with statistical significance (p = 0.001, p < 0.05) congenital AVBpost-surgery AVB

16. analyzing environmental proportions of origin (p=0.001, p < 0.05) congenital AVBpost-surgery AVB

19. post-surgery II AVB post-surgery III AVB

20. III. Results III. Results  Analyzing associated pathology in children, we have found that the delay of the atrioventricular and intraventricular conduction is frequently observed after complex surgeries for congenital heart defects and some of them presenting also heart failure.

21. ASSOCIATED PATHOLOGIES post-surgery II AVB Cardiac CasesPercentages Extra-cardiac CasesPercentages ASD 428.58% Gallbladder malformation 2100% TGA 428.58% VSD 214.28% Mitral insuf. 214.28% Aortic insuf. 214.28%

23. ASSOCIATED PATHOLOGIES post-surgery III AVB Cardiac CasesPercentages Extra-cardiac CasesPercentages VSD 2445.28% Down Syndrome 125% TGA 1426.42% Gallbladder malformation 375% ASD 1018.87% Mitral insuf. 35.66% Aortic insuf. 23.77%

26. Exercise tolerance test  5 exercise tolerance test cases (29 %)  12 cases without exercise tolerance test (71 %)

27. pacemaker 11 cases; pacemaker 6 cases pacemaker 43 cases; pacemaker 31 cases.

28. IV. Discussions Most cases of:  AVB II degree high type has a risk to progress to a complete block.

29.  In postoperative pathology predominates AVB III degree compared to AVB II degree, p = 0.03, p < 0.05.

30. V. Conclusions 1 2 3 4 Congenital AVB is a major rhythm disorder that requires cardiology dispensary. Over 50% of patients require pacemaker implantation. AVB is one of the complications of surgical treatment of CHD. Some of these patients have evolved with the recovery of atrioventricular conduction.

31. Bibliography Bibliography 1. Kastor: Arrhythmias, Second Edition. 2. Edward P. Walsh, J. Philip Saul, John K. Triedman: Cardiac arrhythmias in children and young adults with congenital heart disease. 3. John R. Hampton: The ECG made easy, Seventh Edition.