Permanent Pacemaker Implantation with Near-zero Fluoroscopy in 17-year-old Pregnant Woman with Multiple Aborted Cardiac Arrests caused by Pause-Dependent Torsades de Pointes due to Total Atrioventricular Block and a Prolonged QT Interval
Muzakkir Amir (a), Hafiz Idul Fitranul (a*) Levina (a)

(a) Department of Cardiology and Vascular Medicine
*Jalan Perintis kemerdekaan Km 10, Makassar, South Sulawesi
Corresponding email : muzakkir[at]unhas.ac.id
ORCID ID : 0000-0002-4914-3542

Abstract

Objective: To explain a life-saving procedure on a young pregnant woman with malignant arrhythmia with minimal fluoroscopy
Case report: A 17-year-old female, pregnant for 18 weeks, presented with Torsades de Pointes due to total AV block and prolonged QT interval. The patient experienced multiple defibrillation and a permanent pacemaker was needed to resolve the total AV block. In the absence of non-fluoroscopic measures, we implanted a pacemaker with cumulative dose-area-product of 54.7mGy/cm2 (estimated uterus dose 6.5mGy/cm2), and cumulative air kerma of 0.15mGy. Upon follow-up, the patient gave birth to a normal baby on 34th week of pregnancy.
Conclusion: Permanent pacemaker implantation with near-zero fluoroscopy performed by experienced operator could be an alternative life-saving option for pregnant woman with malignant arrhythmia in a resource-limited center.

Keywords: permanent pacemaker, pregnancy, prolonged QT interval, torsades de pointes, total AV block.

Topic: Communicable diseases related to women