Complete Atrioventricular (AV) Block In 15-Year-Old Girl: A Diagnostic And Therapeutic Challenge In Resource-Limited Setting

Delta Iswara Delta Iswara; Mahardhika Rafif Pratama; Anggita Dian Karera; Yislam Jaidi; Aldila Vidya Ditha Arianti

doi:10.26630/jkmsw.v18i2.5332

Authors

Delta Iswara Delta Iswara Bendan Regional General Hospital
Mahardhika Rafif Pratama Medical Intern, Bendan Regional General Hospital, Central Java, Indonesia
Anggita Dian Karera General Practitioner, An Ni’mah General Hospital, Central Java, Indonesia
Yislam Jaidi Cardiologist, Bendan Regional General Hospital, Central Java, Indonesia
Aldila Vidya Ditha Arianti Pediatrician, Bendan Regional General Hospital, Central Java, Indonesia

DOI:

https://doi.org/10.26630/jkmsw.v18i2.5332

Keywords:

Hyperthermia , Dengue Hemorrhagic Fever , Warm Foot Soak Therapy

Abstract

Complete atrioventricular (AV) block is a rare and life-threatening condition in children, characterized by complete electrical dissociation between the atria and ventricles. Its diagnosis and management can be particularly challenging in resource-limited settings. A 15-year-old girl presented with chest discomfort, dyspnea, nausea, and vomiting. On examination, she was hemodynamically unstable with bradycardia (heart rate 48–58 bpm). Electrocardiography revealed a complete AV block with junctional escape rhythm. Further evaluation, including echocardiography, showed no structural heart defects and preserved ventricular function. Management included fluid resuscitation and dopamine infusion, titrated up to 20 mcg/kg/min. During titration, the patient developed ventricular tachycardia–induced bradycardia that resolved spontaneously after dose reduction. Following stabilization, the patient was referred to a higher-level facility for permanent pacemaker implantation and further investigation of the underlying etiology. This case highlights the importance of early recognition and timely intervention in pediatric complete AV block. In settings with limited resources, dopamine infusion may serve as a temporary bridging therapy when transfer is delayed, but careful monitoring is essential due to the risk of arrhythmias. Prompt diagnosis, appropriate stabilization, and early referral are crucial to reducing morbidity and preventing fatal outcomes.

References

Baruteau, A.-E., Behaghel, A., Fouchard, S., Mabo, P., Schott, J.-J., Dina, C., Chatel, S., Villain, E., Thambo, J.-B., Marçon, F., Gournay, V., Rouault, F., Chantepie, A., Guillaumont, S., Godart, F., Martins, R. P., Delasalle, B., Bonnet, C., Fraisse, A., … Probst, V. (2012). Parental Electrocardiographic Screening Identifies a High Degree of Inheritance for Congenital and Childhood Nonimmune Isolated Atrioventricular Block. Circulation, 126(12), 1469–1477. https://doi.org/10.1161/CIRCULATIONAHA.111.069161

Baruteau, A.-E., Pass, R. H., Thambo, J.-B., Behaghel, A., Le Pennec, S., Perdreau, E., Combes, N., Liberman, L., & McLeod, C. J. (2016). Congenital and Childhood Atrioventricular Blocks: Pathophysiology and Contemporary Management. European Journal of Pediatrics, 175(9), 1235–1248. https://doi.org/10.1007/s00431-016-2748-0

Bordachar, P., Zachary, W., Ploux, S., Labrousse, L., Haissaguerre, M., & Thambo, J.-B. (2013). Pathophysiology, clinical course, and management of congenital complete atrioventricular block. Heart Rhythm, 10(5), 760–766. https://doi.org/10.1016/j.hrthm.2012.12.030

Bustea, C., Radu, A. F., Vesa, C. M., & et al. (2025). Drug-Induced Complete Atrioventricular Block in an Elderly Patient: A Case Report Highlighting Digoxin-Beta Blocker Interactions and a Paradoxical State. Life, 15(2). https://doi.org/10.3390/life15020215

Dewi, T. I., Karwiky, G., Iyos, R. N., & Febrianora, M. (2021). Congenital Complete Heart Block in Young Women. International Journal of Integrated Health Sciences, 9(1), 42–48. https://doi.org/10.15850/ijihs.v9n1.2158

Fedorowski, A., Rosengren, P., Pirouzifard, M., & et al. (2023). Familial Associations of Complete Atrioventricular Block: A National Family Study in Sweden. Circ Genom Precis Med, 16(2), e003654. https://doi.org/10.1161/CIRCGEN.121.003654

Glikson, M., Nielsen, J. C., Kronborg, M. B., & et al. (2021). 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J, 42(35), 3427–3520. https://doi.org/10.1093/eurheartj/ehab364

Kleinman, M. E., Chameides, L., Schexnayder, S. M., Samson, R. A., Hazinski, M. F., Atkins, D. L., Berg, M. D., De Caen, A. R., Fink, E. L., Freid, E. B., & others. (2010). Part 14: Pediatric Advanced Life Support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 122(18_suppl_3), S876–S908. https://doi.org/10.1161/CIRCULATIONAHA.110.971101

Knabben, V., Chhabra, L., & Slane, M. (2025). Third-Degree Atrioventricular Block. StatPearls Publishing.

Kusumoto, F. M., Schoenfeld, M. H., Barrett, C., & et al. (2019). 2018 ACC/AHA/HRS Unusual Course of Congenital Complete Heart Block In an Adult: A Case Reportguideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol, 74(7), e51–e156. https://doi.org/10.1016/j.jacc.2018.10.043

Neumann, J., Hofmann, B., Dhein, S., & Gergs, U. (2023). Role of Dopamine in the Heart in Health and Disease. International Journal of Molecular Sciences, 24(5), 5042. https://doi.org/10.3390/ijms24055042FulltextlinksCite

Oertle, A., Assioun, J., & Schroter, S. (2024). Mobitz Type II Cardiac Conduction Disorder in Adolescent Male. Pediatric Oncall Journal, 23(4). https://doi.org/10.7199/ped.oncall.2026.46

Shah, M. J., Silka, M. J., & Silva, J. N. A. (2021). 2021 PACES Expert Consensus Statement on Indications & Management of Pediatric CIEDs. Heart Rhythm, 18(11), 1888–1924. https://doi.org/10.1016/j.hrthm.2021.07.038

Sonne, J., Goyal, A., & Lopez-Ojeda, W. (2023). Dopamine. StatPearls Publishing.

Su, L. N., Wu, M. Y., Cui, Y. X., Lee, C. Y., Song, J. X., & Chen, H. (2022). Unusual Course of Congenital Complete Heart Block In an Adult: A Case Report. World J Clin Cases, 10(19), 6602. https://doi.org/10.12998/wjcc.v10.i19.6602

Sunbanu, S. E. (2024). Complete Atrioventricular Block in an Adolescent with Acute Rheumatic Fever: Case Report. Paediatr Indones, 64(1), 86–89.

Thambo, J. B., Bordachar, P., Garrigue, S., & et al. (2004). Detrimental Ventricular Remodeling in Patients With Congenital Complete Heart Block and Chronic Right Ventricular Apical Pacing. Circulation, 110(25), 3766–3772. https://doi.org/10.1161/01.CIR.0000150336.86033.8D

Vrdoljak, V., Šapina, M., Bitanga, S., & Katavić, M. (2019). Third Degree Atrioventricular Block in Children. Rad Hrvatske Akademije Znanosti i Umjetnosti Medicinske Znanosti, 540=48–49, 67–70. https://doi.org/10.21857/m3v76t6o3y

Wang, K. (2013). Atlas of Electrocardiography. Jaype Brothers Medical Publishing.