When the Heart Does Not Accelerate and You Cannot Run...

Atrioventricular block in the young is a rare condition. It is defined as congenital when diagnosed in utero, at birth or during the first month of life. Childhood atrioventricular block is defined when diagnosis occurs after the first month of life up to the age of 18 years. It can be isolated (in a structurally normal heart), or associated with a congenital or acquired cardiac disease or other primary causes. The definitive treatment consists of pacemaker implantation for high-risk or symptomatic patients. We report a case of probably idiopathic isolated childhood high-degree atrioventricular block presenting with a long-standing history of effort intolerance, successfully treated with a pacemaker. This case emphasises the importance of correct evaluation of a young patient suffering from effort intolerance and the need to record an ECG when faced with an inadequate heart rate, particularly if accompanied by symptoms. We briefly review the classification, the causes, the clinical picture and the treatment of this uncommon condition.