A Lifeline Through the Umbilicus: Emergency Pacing in Neonatal Complete Heart Block

Complete congenital atrioventricular heart block (CHB) is a rare but serious, life-threatening condition in neonates, most often associated with maternal autoimmune connective tissue disease. Definitive management typically requires epicardial pacing; however, in cases of life‑threatening bradycardia and hemodynamic compromise, temporary transvenous pacing may be lifesaving. Securing vascular access in premature or low‑birth‑weight infants often makes vascular access technically challenging, and conventional routes may not always be feasible. In such situations, the umbilical vein offers a rapid, bedside, and less invasive alternative. We present the case of a premature neonate born at 35 + 1 weeks with congenital third‑degree heart block, in whom emergency temporary pacing was successfully performed via the umbilical vein after failed femoral access, subsequently serving as a bridge to permanent pacemaker implantation.

Keywords: Congenital complete heart block, neonatal lupus, temporary pacing, umbilical vein