Male 9 months with TOF pink type . with Oxygen saturation decreased upto 75% on Inderal 4 mg. TID. Patient had Corrective repair of Tof on the 5th of May2008. Post operative period was uneventful discharge with mild pleural effusion on right side on the 11th of May 2008. He was on Lasix 8mg BID and Spiranolactone 8mg BID. He had 6-8 stools during the hospital stay which increased to 10-15 times a day for two days. He was readmitted to the same hospital with shortness of breath and diarrhoea . His heart rate was 68-88 per minute, Oxygen saturation 100% , Pleural Fluid on right side increased and mild on the left side. Pleural Fluid tapping was done and 80 ml clear fluid removed . Patient developed bradycardia after half an hour of tapping . Then detoriated to complete heartblock. Dobutamine 5 microgram started . Heart rate was 55 -85 per minute . After 24 hours there was sinus bradycardia with 2:1 block. Patient is stable , feeding well, Blood pressure normal, Oxygen Saturation 100%. Presently the patient is on conservative management .
We seek your kind advises on further management . Do we wait for conservative treatment or do we go in for permanent pacemaker.