Paroxysmal AV block medical therapy: Difference between revisions

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==Overview==
==Overview==
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
In patients with [[acute]] onset [[AV block]],[[reversible]] causes such as [[drug]] [[toxicity]],[[thyroid]] dysfunction, [[Lyme disease]], etc should be taken into consideration. A decision should then be made regarding usage of [medical]] therapy or other [[treatment]] modalities such as temporary [[pacing]]. [[Theophylline]] is an [[adenosine]] [[antagonist]] that may be used in the diagnosis of extrinsic [[vagal]] [[paroxysmal AV Block]].  


OR
=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Acute Management of Reversible Causes of Bradycardia Attributable to Atrioventricular Block=


Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: LightGreen"|[[2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay| Recommendations for Acute Management of Reversible Causes of Bradycardia Attributable to Atrioventricular Block]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Patients with transient or reversible causes of atrioventricular block, such as Lyme carditis or drug toxicity, should have medical therapy and supportive care, including temporary transvenous pacing if necessary, before determination of need for permanent pacing. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]]''


OR
'''2.''' In selected patients with symptomatic second-degree or third-degree atrioventricular block who are on chronic stable doses of medically necessary antiarrhythmic or betablocker therapy, it is reasonable to proceed to permanent pacing without further observation for drug washout or reversibility. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>''


The majority of cases of [disease name] are self-limited and require only supportive care.
'''3.''' In patients with second-degree or third degree atrioventricular block associated with cardiac sarcoidosis, permanent pacing, with additional defibrillator capability if needed and meaningful survival of greater than 1 year is expected, without further observation for reversibility is reasonable. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>''


OR
'''4.''' In patients with symptomatic second degree or third-degree atrioventricular block associated with thyroid function abnormalities but without clinical myxedema, permanent pacing without further observation for reversibility may be considered. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>''<nowiki>"</nowiki>
|}


[Disease name] is a medical emergency and requires prompt treatment.
=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Acute Medical Therapy for Bradycardia Attributable to Atrioventricular Block=
{|class="wikitable"
|-
| colspan="1" style="text-align:center; background: LightGreen"|[[2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay| Recommendations for Acute Medical Therapy for Bradycardia Attributable to Atrioventricular Block]]
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' For patients with second-degree or third degree atrioventricular block believed to be at the atrioventricular nodal level associated with symptoms or hemodynamic compromise, atropine is reasonable to improve atrioventricular conduction,increase ventricular rate, and improve symptoms ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]]<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>''


OR
'''2.''' For patients with second-degree or thirddegree atrioventricular block associated with symptoms or hemodynamic compromise and who have low likelihood for coronary ischemia, beta-adrenergic agonists, such as isoproterenol, dopamine, dobutamine, or epinephrine, may be considered to improve atrioventricular conduction, increase ventricular rate, and improve symptoms.''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>''


The mainstay of treatment for [disease name] is [therapy].
'''3.'''For patients with second-degree or thirddegree atrioventricular block associated with symptoms or hemodynamic compromise in the setting of acute inferior MI, intravenous
aminophylline may be considered to improve atrioventricular conduction, increase ventricular rate, and improve symptoms. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C-LD]])<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>'' <nowiki>"</nowiki>
|}


OR
*The [[acute]] [[treatment]] of [[bradycardia]] attributable to [[atrioventricular block]] will often begin with timely identification and removal of potential causative factors as well as medical therapy.  
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.


OR
===Atropine===


[Therapy] is recommended among all patients who develop [disease name].
*[[Atropine]] is a parasympatholytic drug that has a short duration of action, is easy to [[administer]] and has relatively low risk of adverse reactions (except for obvious [[antimuscarinic]] actions).
* It is effect for blocks at the level of the [[AV node]] and [[bradycardia]] secondary to increased [[vagal]] tone. It should be used judiciously in patients with [[AV blocks]] at the [[His-Purkinje]] or [[His bundle]] level as it may worsen the patients condition. <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>


OR
===Beta-adrenergic agonists===
*[[Beta-adrenergic]] agonists such as [[isoproterenol]], [[dopamine]], [[dobutamine]], and [[epinephrine]] exert direct effects to enhance [[atrioventricular]] nodal and [[His-Purkinje]] [[conduction]].
*Adverse effects of [[beta-adrenergic]] agonists may include [[ventricular arrhythmias]], [[excacerbation of coronary ischemia]] and [[hypotension]]. <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>


Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
===Amminophylline===
*[[Aminophylline]] is a nonselective [[adenosine]] receptor [[antagonist]] and [[phosphodiesterase inhibitor]].
*It is used clinically as a [[bronchodilator]] and as a reversal drug for [[dipyridamole]], [[adenosine]], and [[regadenoson]] in [[pharmacologic]] nuclear stress testing.
*It has a possible role in the treatment of [[AV block]] but sparse literature is available regarding this. <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>


OR
[[Image:Acute_Medical_Management_of_AV_block_or_SND.JPG|thumb|center|500px|Acute Medical Management of AV Block or Sinus node dysfunction <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>]]


Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
==Theophylline==
*[[Theophylline]] is a '''non-selective [[adenosine]] [[antagonist]]''' that may be employed in the treatment of EI-AVB.
*It exerts a '''positive [[chronotropic]] and [[dromotropic]] effect'''.
*'''A study conducted by Benditt et al''' showed that [[theophylline]] shortened the minimum [[atrial]] paced cycle length, maintained 1:1 [[AV]] conduction and consistently reduced [[AV node]] functional refractory periods. <ref name="pmid6359850">{{cite journal| author=Benditt DG, Benson DW, Kreitt J, Dunnigan A, Pritzker MR, Crouse L | display-authors=etal| title=Electrophysiologic effects of theophylline in young patients with recurrent symptomatic bradyarrhythmias. | journal=Am J Cardiol | year= 1983 | volume= 52 | issue= 10 | pages= 1223-9 | pmid=6359850 | doi=10.1016/0002-9149(83)90578-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6359850  }} </ref>


OR
*In two small [[observational studie]]s, '''[[oral]] [[theophylline]] appeared to be effective over a [[mean]] follow-up of 16 and 17 months in patients with an established diagnosis of EI-AVB''' and '''may be considered an alternative to permanent [[pacing]] in such patients'''.
 
*No studies on the role of theophylline in I-AVB are available.  
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*A few small [[observational studies]] on patients with EV-AVB treated with [[theophylline]] have recorded a [[recurrence rate]] ranging between 12% and 22%.  
 
*In a [[randomized controlled trial]],[[theophylline]] proved ineffective in preventing [[reflex]] [[syncope]] in patients affected by [[sick sinus syndrome]] compared with the not [[treatment]] arm. {{cite web |url=https://onlinelibrary.wiley.com/doi/pdf/10.1016/j.joa.2017.03.008 |title=Syncope and paroxysmal atrioventricular block - Aste - 2017 - Journal of Arrhythmia - Wiley Online Library |format= |work= |accessdate=}}
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
===Disease Name===
 
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Latest revision as of 06:50, 11 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]

Overview

In patients with acute onset AV block,reversible causes such as drug toxicity,thyroid dysfunction, Lyme disease, etc should be taken into consideration. A decision should then be made regarding usage of [medical]] therapy or other treatment modalities such as temporary pacing. Theophylline is an adenosine antagonist that may be used in the diagnosis of extrinsic vagal paroxysmal AV Block.

2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Acute Management of Reversible Causes of Bradycardia Attributable to Atrioventricular Block

Recommendations for Acute Management of Reversible Causes of Bradycardia Attributable to Atrioventricular Block
"1. Patients with transient or reversible causes of atrioventricular block, such as Lyme carditis or drug toxicity, should have medical therapy and supportive care, including temporary transvenous pacing if necessary, before determination of need for permanent pacing. (Level of Evidence: B-NR

2. In selected patients with symptomatic second-degree or third-degree atrioventricular block who are on chronic stable doses of medically necessary antiarrhythmic or betablocker therapy, it is reasonable to proceed to permanent pacing without further observation for drug washout or reversibility. (Level of Evidence: B-NR)[1]

3. In patients with second-degree or third degree atrioventricular block associated with cardiac sarcoidosis, permanent pacing, with additional defibrillator capability if needed and meaningful survival of greater than 1 year is expected, without further observation for reversibility is reasonable. (Level of Evidence: B-NR)[1]

4. In patients with symptomatic second degree or third-degree atrioventricular block associated with thyroid function abnormalities but without clinical myxedema, permanent pacing without further observation for reversibility may be considered. (Level of Evidence: C-LD)[1]"

2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Acute Medical Therapy for Bradycardia Attributable to Atrioventricular Block

Recommendations for Acute Medical Therapy for Bradycardia Attributable to Atrioventricular Block
"1. For patients with second-degree or third degree atrioventricular block believed to be at the atrioventricular nodal level associated with symptoms or hemodynamic compromise, atropine is reasonable to improve atrioventricular conduction,increase ventricular rate, and improve symptoms (Level of Evidence: C-LD[1]

2. For patients with second-degree or thirddegree atrioventricular block associated with symptoms or hemodynamic compromise and who have low likelihood for coronary ischemia, beta-adrenergic agonists, such as isoproterenol, dopamine, dobutamine, or epinephrine, may be considered to improve atrioventricular conduction, increase ventricular rate, and improve symptoms.(Level of Evidence: B-NR)[1]

3.For patients with second-degree or thirddegree atrioventricular block associated with symptoms or hemodynamic compromise in the setting of acute inferior MI, intravenous aminophylline may be considered to improve atrioventricular conduction, increase ventricular rate, and improve symptoms. (Level of Evidence: C-LD)[1] "

Atropine

Beta-adrenergic agonists

Amminophylline

Acute Medical Management of AV Block or Sinus node dysfunction [1]

Theophylline

  • In two small observational studies, oral theophylline appeared to be effective over a mean follow-up of 16 and 17 months in patients with an established diagnosis of EI-AVB and may be considered an alternative to permanent pacing in such patients.
  • No studies on the role of theophylline in I-AVB are available.
  • A few small observational studies on patients with EV-AVB treated with theophylline have recorded a recurrence rate ranging between 12% and 22%.
  • In a randomized controlled trial,theophylline proved ineffective in preventing reflex syncope in patients affected by sick sinus syndrome compared with the not treatment arm. "Syncope and paroxysmal atrioventricular block - Aste - 2017 - Journal of Arrhythmia - Wiley Online Library".

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society". J Am Coll Cardiol. 74 (7): 932–987. doi:10.1016/j.jacc.2018.10.043. PMID 30412710.
  2. ↑ Benditt DG, Benson DW, Kreitt J, Dunnigan A, Pritzker MR, Crouse L; et al. (1983). "Electrophysiologic effects of theophylline in young patients with recurrent symptomatic bradyarrhythmias". Am J Cardiol. 52 (10): 1223–9. doi:10.1016/0002-9149(83)90578-7. PMID 6359850.


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