Second degree AV block natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Patients with Mobitz type II second degree AV block who are hemodynamically stable do not require urgent therapy with atropine or temporary cardiac pacing. However, Mobitz type II second degree AV block is by nature unstable and frequently progresses to third degree (complete) AV block, so patients should be continuously monitored with transcutaneous pacing pads in place in the event of clinical deterioration. While stable patients are being monitored, reversible causes of Mobitz type II second degree AV block such as myocardial ischemia, increased vagal tone, hypothyroidism, hyperkalemia, and drugs that depress conduction, should be excluded in patients prior to implantation of a permanent pacemaker. For patients with Mobitz type II second degree AV block who do not have a reversible etiology, we recommend implantation of a permanent pacemaker (Grade 1A). We implant a dual chamber DDD pacemaker whenever possible in an effort to maintain physiologic AV synchrony.
Natural History
- Second-degree AV nodal block commonly is seen in acute clinical settings including acute inferior wall myocardial infarction, digitalis intoxication, myocarditis, rheumatic fever), after cardiac surgery.
- Chronic AV nodal block is seen in the setting of ischemic heart disease, mesothelioma of the AV node, atrial septal defect, aortic valvular disease, amyloidosis, Reiter's syndrome, mitral valve prolapse, in healthy populations , and in trained athletes.[1].
- Mobitz II second degree Av block due to block inferior to the AV node (infra-Hisian structures) may progresses to complete heart block.[2].
Complications
Prognosis
Prognosis is generally good in patients with chronic second-degree AV nodal block without organic heart disease.However, in patients with organic heart disease, prognosis is poor and related to the severity of underlying heart disease.[5]
References
- ↑ Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM (May 1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–9. doi:10.1161/01.cir.63.5.1043. PMID 7471363.
- ↑ Rodstein M, Wolloch L, Iuster Z (1979). "The natural history intraventricular conduction disturbances in the aged: an analysis of the developing second and third degree heart block with clinical pathological correlations". Am. J. Med. Sci. 277 (2): 179–88. doi:10.1097/00000441-197903000-00006. PMID 463945.
- ↑ Bexton RS, Camm AJ (March 1984). "Second degree atrioventricular block". Eur. Heart J. 5 Suppl A: 111–4. doi:10.1093/eurheartj/5.suppl_a.111. PMID 6373268.
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(help) - ↑ Strasberg, B; Amat-Y-Leon, F; Dhingra, R C; Palileo, E; Swiryn, S; Bauernfeind, R; Wyndham, C; Rosen, K M (1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–1049. doi:10.1161/01.CIR.63.5.1043. ISSN 0009-7322.