Anesthetic management of a cesarean section in a pregnant patient with congenital complete atrioventricular block without pacemaker – A case report

Congenital complete atrioventricular block (CCAVB) is a rare but high-risk condition with significant maternal and fetal morbidity and mortality. Management often involves pacemaker implantation, yet anesthetic guidelines for pregnant women with CCAVB remain unclear. We describe the anesthetic care of a 29-year-old primigravida with asymptomatic CCAVB (no pacemaker) and well-controlled Crohn's disease, who underwent urgent cesarean delivery at 34+5 weeks for severe preeclampsia. A multidisciplinary team developed a detailed perioperative plan. On the day of surgery, defibrillator pads were applied, an arterial line was placed, and a cardiologist was present with electrophysiology backup. Pre-anesthetic fluid status was assessed with transthoracic echocardiography. Epidural anesthesia was cautiously titrated using 0.75% ropivacaine (16 mL) and sufentanil 10 µg over 20 minutes. The procedure was uneventful, with no need for pacing or vasopressors. A healthy newborn was delivered. The patient recovered in level 2 care and was discharged on postoperative day 3. This case underscores the importance of multidisciplinary planning and cautious epidural anesthesia in CCAVB pregnancies without pacing.