Complete atrioventricular block during neonatal intubation: a case report

Preterm infants often experience side effects from intubation. Desaturation and sinus bradycardia are frequent. Atropine as premedication mitigates these risks. We report the occurrence of severe bradycardia related to atrioventricular block during intubation. The infant experienced severe bradycardia not responsive to effective endotracheal ventilation. The electrocardiogram trace displayed an initial 2:1 Mobitz II block with a rapid progression to complete atrioventricular block. Congenital atrioventricular block is mostly related to atrioventricular node lesions by maternal anti-SSA/anti-SSB antibodies, but, in some cases, atrioventricular block may be paroxysmal and vagally mediated. Although most rhythm disturbances secondary to intubation are sinus bradycardias, other bradyarhythmia, such as atrioventricular block, should be considered and treated rapidly. Clues for non-sinus bradycardia include initial sharp decrease in heart rate, and a fixed low heart rate despite adequate ventilation.