conservative management of bradycardia

Male 9 months with TOF pink type . with Oxygen saturation decreased upto 75% on Inderal 4 mg. TID. Patient had Corrective repair of Tof on the 5th of May2008. Post operative period was uneventful discharge with mild pleural effusion on right side on the 11th of May 2008. He was on Lasix 8mg BID and Spiranolactone 8mg BID. He had 6-8 stools during the hospital stay which increased to 10-15 times a day for two days. He was readmitted to the same hospital with shortness of breath and  diarrhoea . His heart rate was 68-88 per minute, Oxygen saturation 100% , Pleural Fluid on right side increased and mild on the left side. Pleural Fluid tapping was done and 80 ml clear fluid removed . Patient developed bradycardia after half an hour of tapping . Then detoriated to complete heartblock. Dobutamine 5 microgram started . Heart rate was 55 -85 per minute . After 24 hours there was sinus bradycardia with 2:1 block. Patient is stable , feeding well, Blood pressure normal, Oxygen Saturation 100%. Presently the patient is on conservative management .

We seek your kind advises on further management .  Do we wait for conservative treatment or do we go in for permanent pacemaker.

[Michael J. McWilliams, M.D.]

I am sorry but I have no experience in neonatal electrophysiology.  I know this must be hard on you.  You need to seek the advise of an experienced pediatric electrophysiologist.  I wish you the best.

[syed_adeeb]

you can at least guide me by giving the address of any paediatric cardiologist or can have a discussion with doctors in your hospital.please help my child. do sedatives have any effect on the heart rate because they are giving my child chloralhydrate at night to make him sleep.since birth my child has habit of not sleeping at night ,he is playful,sleep during morning hours.Here nurses cannot afford to be awake with him so they are giving him sedative.please give me your valuable advise.I am waiting to hear from you . thank you.

[Michael J. McWilliams, M.D.]

There are no pediatric cardiologists in my community.  the best advise I could give you if your child is very sick is to get to a high volume teaching hospital that specializes in congenital heart disease.  I can't really give advise on children that young because I have no experience in that area.