FROM DIAGNOSIS TO DELIVERY: A CASE OF ASYMPTOMATIC TOTAL ATRIOVENTRICULAR BLOCK IN A PREGNANT WOMAN

Abstract

Background: Bradyarrhythmias are infrequently encountered in women of reproductive age and are even less common during pregnancy, with an estimated prevalence of approximately 1 in 15,000. Total atrioventricular block (TAVB) identified during pregnancy is most often congenital in origin. In cases involving high-risk pregnancies, cardiac pacing can be safely administered under careful clinical supervision. Vaginal delivery is generally considered safe and does not confer additional risk, whereas cesarean section is reserved for established obstetric indications. Case Description: A 38-year-old pregnant woman at 38 weeks of gestation presented with bradycardia, and electrocardiographic evaluation revealed a total atrioventricular block (TAVB). Despite a heart rate of 41 beats per minute, she remained asymptomatic. Given that she had no prior history of pacemaker implantation, an urgent cardiology consultation was arranged. Subsequently, a transvenous temporary pacemaker was inserted prior to delivery. The patient underwent a cesarean section under spinal anesthesia and experienced an uneventful postoperative recovery. Conclusion: Management of total atrioventricular block during pregnancy requires a multidisciplinary approach involving both obstetricians and cardiologists. The implantation of a pacemaker is recommended and can be safely performed in high-risk pregnancies with appropriate monitoring. While cesarean section may be indicated based on obstetric factors, vaginal delivery remains the preferred mode of delivery when clinically feasible.