Treatment of heart block in children.

Congenital or acquired complete heart block, though a rare disease in childhood, may raise difficult problems of management. Congenital complete heart block is compatible with normal development and survival (Yater, 1929; Campbell and Thorne, 1956; Donoso, Braunwald, Jick, and Grushman, 1956; Ikkos and Hanson, 1960; Hill, 1963; Nakamura and Nadas, 1964), but there is no doubt that Stokes-Adams attacks, though rare, can occur, and probably reflect a poor prognosis (Smithells and Outon, 1959; Molthan, Miller, Hastreiter, and Paul, 1962; Nakamura and Nadas, 1964). The surgical correction of congenital abnormalities particularly ventricular septal defect, produced a number of instances of complete heart block, and though the incidence of this complication has decreased with improved techniques, it still occasionally occurs, and if associated with Stokes-Adams attacks is reported to have a high mortality (Reemtsma, Delgado, and Creech, 1960; McGoon, Ongley, and Kirklin, 1964a). In recent years efforts have been made to provide post-operative and long-term treatment for post-operative heart block (Brockman, Webb, and Bahnson, 1958; Weirich and Roe, 1961; Lillehei, Levy, Bonnabeau, Long, and Sellers, 1964a, b), since up until now it has generally been agreed that the prognosis is so poor that artificial pacing should always be instituted. Stokes-Adams attacks in children with non-surgical heart block can, however, be controlled with isoprenaline-l-a ('saventrine'), and it is possible that drug therapy may avoid pacing in some cases of post-surgical block. We now report our experience with the treatment of 3 children with heart block.