Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Congenital Complete Atrioventricular Block (CCAVB) is a rare and potentially serious condition with an important morbi-mortality risk. Treatment, when appropriate, involves implanting a permanent pacemaker. Currently, there are no specific guidelines for the anesthetic management of pregnant women with CCAVB.

Methods Description of the anesthetic management during a cesarean section for a pregnant woman with CCAVB with no pacemaker.

Results A 29 year-old primipara was admitted for elective C-Section at 35 weeks due to severe pre-eclampsia. She had asymptomatic CCAVB and controlled Crohn’s disease. A multidisciplinary meeting was convened to plan the surgery. On the day of surgery, multifunction pads were placed on standby and an arterial line to continuously monitor blood pressure. A cardiologist was on-site and the electrophysiologist team was forewarned of possible emergent need for transvenous pacemaker. An adequate preload was done according to TTE findings before realizing the epidural block for which a total of 16mL of ropivacaine 0,75% plus 10mcg sufentanil were injected in 20min in bolus of 3-5mL. The surgery was uneventful, without the need for pacing nor use of vasopressor/chronotropic drugs, and a healthy baby was delivered. The patient had an uneventful 24-hour stay in level 2 critical care, being discharged at the third day, without complications.

Conclusions We show a successful case of an epidural block in a CCAVB pregnant patient with no pacemaker. The approach to this population should be multidisciplinary. The decision to place a prophylactic temporary pacemaker should be individualized, but a team should be ready to emergently implant one.