A successful pregnancy outcome in a patient with cardiac permanent pacemaker

We present a case of 31 years old Gravida 2 Abortion 1 at 25 weeks of gestation with history of congenital heart disease- Left aorto-ventricular tunnel, for which she had intracardiac repair at 7 years of age. She had bradycardia, syncopal attacks, diagnosed as complete heart block at 26 yrs of age and had permanent pacemaker implantation had come for antenatal care. Echocardiogram showed ejection fraction of 30%, global hypokinesia of left ventricle and moderate aortic regurgitation. Patient was asymptomatic. As per cardiologist opinion, started on Tab. Amiodarone 100mg once daily on alternate days and pregnancy continued. Patient was admitted at 38wks, for elective lower segment caesarean section, in view of cardiac condition, pacemaker adjustment done before anaesthesia. Under general anaesthesia, delivered an alive boy baby of birth weight 3.2 kg with a good Apgar score. Intraoperative and postoperative period was uneventful. At postoperative follow-up, patient was asymptomatic. Hence, we report a successful pregnancy outcome despite critical ejection fraction in a pregnant patient with permanent pacemaker.