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Case Reports
. 2022 Nov 14;6(11):ytac428.
doi: 10.1093/ehjcr/ytac428. eCollection 2022 Nov.

A case report of paroxysmal complete atrioventricular block in a patient with dextrocardia and repaired tetralogy of Fallot

Takeshi Fujita  1 , Akira Yoshida  1 , Minoru Ichikawa  1
Affiliations
Case Reports

A case report of paroxysmal complete atrioventricular block in a patient with dextrocardia and repaired tetralogy of Fallot

Takeshi Fujita et al. Eur Heart J Case Rep. .

Abstract

Background: Some adults suffer sudden cardiac death after previous surgical repair of tetralogy of Fallot (TOF), and in such cases, ventricular tachycardia is believed to be the most frequent cause of death. However, we report a case of cardiac arrest due to paroxysmal complete atrioventricular block in an adult with dextrocardia and repaired TOF.

Case summary: A 49-year-old woman with dextrocardia and a history of surgical treatment for TOF lost consciousness three times. A previously implanted loop recorder showed a 60-second cardiac arrest, and complete atrioventricular block was diagnosed. An electrophysiological study showed prolongation of the His-ventricular interval but no ventricular tachycardia. A dual chamber pacemaker was implanted, and there has been no recurrence of syncope in the 23 months since implantation.

Discussion: There is little evidence for paroxysmal complete atrioventricular block in patients with repaired TOF. This case suggests that paroxysmal complete atrioventricular block can occur late after surgical repair of TOF, and research needs to elucidate whether it is the cause of sudden cardiac death in some patients with TOF.

Keywords: Case report; dextrocardia; paroxysmal complete atrioventricular block; sudden cardiac death; tetralogy of Fallot.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
An implantable loop recorder (confirm rx™) recorded a bradycardia event. The patient was in complete atrioventricular block for 60 seconds.
Figure 2
Figure 2
(A) Twelve-lead electrocardiogram showing sinus rhythm and three bundle blocks (first-degree atrioventricular block, complete right bundle branch block, and left anterior hemiblock) (B) chest X-ray showing dextrocardia.
Figure 3
Figure 3
Record from the implantable loop recorder showing the complete atrioventricular block, which is a 5.5 times magnification of Figure 1. ▼: onset of the pause with third-degree atrioventricular block. ▼: regular P waves during the pause.
Figure 4
Figure 4
(A) Fluoroscopic images of electrophysiology catheters position in situs inversus and dextrocardia (right anterior oblique view). (B) Electrophysiological study showing first-degree His-ventricular block (heart rate, 67 bpm; atrio-His interval, 105 milliseconds; His-ventricular interval, 66 milliseconds). The maximum sinus node recovery time was 1220 milliseconds, and the Wenckebach rate was 140 ppm. Ventricular tachycardia was not induced by extra single, double, triple, or burst pacing at the right ventricular outflow and apex. RA, right apex; RV, right ventricle.
Figure 5
Figure 5
A dual chamber pacemaker was implanted with the A-lead in the right atrial appendage and the V-lead in the right ventricular apex.
See this image and copyright information in PMC

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