Dhiman Niharika, Sarda Nivedita, Arora Renu
Obstetrics and Gynaecology Department, Safdarjung Hospital, New Delhi, India.
J Obstet Gynaecol Res. 2013 Feb;39(2):588-91. doi: 10.1111/j.1447-0756.2012.01983.x. Epub 2012 Sep 25.
A 22-year-old second gravida presented to the antenatal clinic at 28 weeks of gestation with frequent fainting attacks (2-3 episodes/day), palpitations and dyspnea (New York Heart Association Functional Classification II). Her pulse rate was 40 b.p.m. A 12-lead electrocardiogram and 24-h Holter revealed complete heart block. A transvenous permanent pacemaker (ventricular demand rate-responsive), paced at a rate of 60 pulses/min, was successfully implanted. A multidisciplinary approach was taken and the patient delivered a healthy baby boy of 2.8 kg at 38 weeks. She remained asymptomatic and was discharged in good condition. Management varies from expectant management to temporary pacemaker insertion to permanent pacing during pregnancy. In a young patient with sinus bradycardia, the primary criterion for a pacemaker is the concurrent observation of a symptom (e.g., syncope) with bradycardia (e.g., heart rate 35-40 b.p.m. or asystole for 3 s). Symptomatic pregnant women should always be counseled for a permanent pacemaker.
一名22岁的经产妇在妊娠28周时前往产前诊所就诊，她频繁出现昏厥发作（每天2 - 3次）、心悸和呼吸困难（纽约心脏协会心功能分级II级）。她的脉搏率为40次/分钟。12导联心电图和24小时动态心电图显示完全性心脏传导阻滞。成功植入了一台经静脉永久性起搏器（心室按需型频率应答式），起搏频率为60次/分钟。采取了多学科方法，患者在38周时产下一名体重2.8千克的健康男婴。她仍无症状，状况良好出院。孕期的管理方式从期待管理到临时起搏器植入再到永久性起搏不等。对于患有窦性心动过缓的年轻患者，起搏器植入的主要标准是同时观察到症状（如晕厥）和心动过缓（如心率35 - 40次/分钟或心脏停搏3秒）。有症状的孕妇应始终接受关于永久性起搏器的咨询。
