Third degree AV block diagnostic study of choice
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Qasim Khurshid, M.B.B.S [3].
Overview
A 12-lead Electrocardiography (ECG) is the gold standard test for the diagnosis of third degree AV block. Nevertheless, it might be normal in patients with transient AV block. A Holter monitoring and/or telemetry must be performed when the patient presents with signs and symptoms which raising concern for complete heart block in the presence of a normal ECG. Diagnostic electrophysiologic studies might be used in certain complicated cases
Diagnostic Study of Choice
Study of choice
A 12-lead Electrocardiography (ECG) is the gold standard test for the diagnosis of third degree AV block.
Nevertheless, it might be normal in patients with transient AV block.
A Holter monitoring and/or telemetry must be performed when a patient presents with sign and symptoms which raising concern for transient complete heart block such as:
- Syncope
- History of Heart disease
- Elderly
- History of taking AV blocking agents
- History of heart surgery
- Patients with third-degree AV block will have evidence of P wave and QRS complexes that are independent of each other.
- In the majority of the cases, the atrial rate will be faster than the ventricular escape rate, and there will be no association between the P waves and QRS complexes.
- With a very few exceptions, electrophysiologic studies are not necessary in patients with complete AV block.[1][2]
References
- ↑ Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281-2329. doi:10.1093/eurheartj/eht150
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published correction appears in J Am Coll Cardiol. 2019 Aug 20;74(7):1016-1018]. J Am Coll Cardiol. 2019;74(7):e51-e156. doi:10.1016/j.jacc.2018.10.044