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Late complete heart block post-tetralogy of Fallot repair: a possible new predicting, precipitating factor and review of related cases
  1. Rayan Hejazi1,
  2. Marwan Balubaid2,
  3. Jameel Alata1 and
  4. Rahaf Waggass1,2
  1. 1 National Guard Health Affairs, Jeddah, Saudi Arabia
  2. 2 Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
  1. Correspondence to Dr Rahaf Waggass, dr_rahaf_waggass{at}


Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease beyond the age of 3 months. Complete heart block (CHB) is rare but a serious sequalae post-repair of TOF. We present a case of an 18-month-old child who developed late CHB after around 1 year of the corrective surgery of the congenital anomaly. On the regular follow-up visit, the patient assessment was unremarkable. However, there was bradycardia, 55 beats/min. The ECG showed complete atrioventricular dissociation. Echocardiogram was done and demonstrated severe tricuspid regurgitation (TR). The patient required a permanent pacemaker and he is currently well. We are presenting this case as a late unexpected CHB, with a possibility of progressive right-side dilatation as a contributing factor to CHB due to severe TR.

  • arrhythmias
  • pacing and electrophysiology
  • valvar diseases
  • interventional cardiology

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  • Contributors RW diagnosed the patient and followed him. He is the most responsible physician who was caring for the patient. RW discussed the importance of the case with JA and planned to prepare it for publication. RH and MB were involved in conducting the research including gaining the consent, collecting the data and writing. RW and JA encouraged RH and MB to include relevant data from important published research articles and use proper citation. JA added and modified the end point of conclusion addressing the possibly new risk factor of right ventricular dilatation as a cause for late complete heart block in this case. RW supervised the team and provided modifications. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.