Third degree AV block natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
The majority of the patients with complete heart block do not recover spontaneously. Untreated complete heart block is associated with high morbidity and mortality. Patients with complete heart blocks are prone to [[Perfusion|decreased perfusion]] related to symptomatic [[bradycardia]] and [[Cardiac output|decreased cardiac output]]. Common | The majority of the patients with [[complete heart block]] do not recover spontaneously. Untreated [[complete heart block]] is associated with high [[morbidity]] and [[mortality]]. [[Patients]] with [[complete heart blocks]] are prone to [[Perfusion|decreased perfusion]] related to symptomatic [[bradycardia]] and [[Cardiac output|decreased cardiac output]]. Common [[Complications]] of [[third-degree AV block]] include [[sudden cardiac death]] due to [[asystole]], [[syncope]], and [[Musculoskeletal|musculoskeletal injuries]] secondary to fall after [[syncope]]. The prognosis of the [[third-degree heart block]] is most likely dependent on the [[patient]]'s underlying [[disease]] burden and severity of the [[clinical]] presentation on arrival. [[Patients]] treated with permanent [[Pacemaker|pacemakers]] have an excellent [[prognosis]]. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* Spontaneous recovery from third degree heart block is very rare. | * Spontaneous recovery from [[third-degree heart block]] is very rare. | ||
* The estimated overall mortality of non-paced patients with isolated AV block is 8%–16% in [[infants]] and 4%–8% in children and adults.<ref name="pmid30821295">{{cite journal |vauthors=Proclemer A, Zecchin M, D'Onofrio A, Ricci RP, Boriani G, Rebellato L, Ghidina M, Bianco G, Bernardelli E, Miconi A, Zorzin AF, Gregori D |title=[The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2017] |language=Italian |journal=G Ital Cardiol (Rome) |volume=20 |issue=3 |pages=136–148 |date=March 2019 |pmid=30821295 |doi=10.1714/3108.30963 |url=}}</ref><ref name="pmid28630373">{{cite journal |vauthors=Merchant FM, Hoskins MH, Musat DL, Prillinger JB, Roberts GJ, Nabutovsky Y, Mittal S |title=Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing |journal=Circ Cardiovasc Qual Outcomes |volume=10 |issue=6 |pages= |date=June 2017 |pmid=28630373 |doi=10.1161/CIRCOUTCOMES.117.003564 |url=}}</ref> | * The estimated overall [[mortality]] of non-paced patients with isolated AV block is 8%–16% in [[infants]] and 4%–8% in [[children]] and [[adults]].<ref name="pmid30821295">{{cite journal |vauthors=Proclemer A, Zecchin M, D'Onofrio A, Ricci RP, Boriani G, Rebellato L, Ghidina M, Bianco G, Bernardelli E, Miconi A, Zorzin AF, Gregori D |title=[The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2017] |language=Italian |journal=G Ital Cardiol (Rome) |volume=20 |issue=3 |pages=136–148 |date=March 2019 |pmid=30821295 |doi=10.1714/3108.30963 |url=}}</ref><ref name="pmid28630373">{{cite journal |vauthors=Merchant FM, Hoskins MH, Musat DL, Prillinger JB, Roberts GJ, Nabutovsky Y, Mittal S |title=Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing |journal=Circ Cardiovasc Qual Outcomes |volume=10 |issue=6 |pages= |date=June 2017 |pmid=28630373 |doi=10.1161/CIRCOUTCOMES.117.003564 |url=}}</ref> | ||
* If left untreated third degree heart block is associated with | * If left untreated, [[third-degree heart block]] is associated with high [[mortality]] which appears to occur as a consequence of the [[complications]] of [[prematurity]] and [[bradycardia]] owing to the delayed initiation of [[pacing]] therapy. | ||
===Complications=== | ===Complications=== | ||
* Patients with | * [[Patients]] with [[complete heart block]] are susceptible to [[hypotension]] related to decreased [[cardiac output]] and [[bradycardia]].<ref name="pmid23255456">{{cite journal |vauthors=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO |title=2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society |journal=Circulation |volume=127 |issue=3 |pages=e283–352 |date=January 2013 |pmid=23255456 |doi=10.1161/CIR.0b013e318276ce9b |url=}}</ref> | ||
* | * [[Patients]] with [[Hemodynamically|hemodynamic]] instability may be unable to protect their [[airway]] due to [[altered mental status]] leading to an [[Aspiration pneumonia|aspiration]] that has high [[morbidity]] and [[mortality]]. | ||
* | * Complications related to [[pace maker]] implantation include malposition or dislodgement of a [[pacemaker]] leads and [[cardiac]] perforation. | ||
*Common complications of third degree AV block include: | *Common complications of [[third degree AV block]] include: | ||
** Sudden cardiac death due to [[asystole]] | ** [[Sudden cardiac death]] due to [[asystole]] | ||
** [[Syncope]] | ** [[Syncope]] | ||
** [[Musculoskeletal|Musculoskeletal injuries]] secondary to fall after [[syncope]]. | ** [[Musculoskeletal|Musculoskeletal injuries]] secondary to fall after [[syncope]]. | ||
**Cardiovascular collapse | **[[Cardiovascular]] collapse | ||
**[[Hypotension]] | **[[Hypotension]] | ||
**[[Stokes-Adams syndrome]] | **[[Stokes-Adams syndrome]] | ||
**[[Ventricular tachycardia]] | **[[Ventricular tachycardia]]<ref name="pmid2426671">{{cite journal |vauthors=Strasberg B, Kusniec J, Erdman S, Lewin RF, Arditti A, Sclarovsky S, Agmon J |title=Polymorphous ventricular tachycardia and atrioventricular block |journal=Pacing Clin Electrophysiol |volume=9 |issue=4 |pages=522–6 |date=July 1986 |pmid=2426671 |doi=10.1111/j.1540-8159.1986.tb06609.x |url=}}</ref><ref name="pmid19545348">{{cite journal |vauthors=Tanaka Y, Yamabe H, Yamasaki H, Tsuda H, Nagayoshi Y, Kawano H, Kimura Y, Hokamura Y, Ogawa H |title=A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma |journal=Pacing Clin Electrophysiol |volume=32 |issue=6 |pages=816–9 |date=June 2009 |pmid=19545348 |doi=10.1111/j.1540-8159.2009.02372.x |url=}}</ref> | ||
**[[Ventricular fibrillation]] | **[[Ventricular fibrillation]] | ||
** Worsening of [[heart failure]] | ** Worsening of [[heart failure]] | ||
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==Prognosis== | ==Prognosis== | ||
* The prognosis of third degree heart block is most likely dependent on the patient's underlying disease burden and severity of the clinical presentation on arrival.<ref name="pmid28267964">{{cite journal |vauthors=Kosmidou I, Redfors B, Dordi R, Dizon JM, McAndrew T, Mehran R, Ben-Yehuda O, Mintz GS, Stone GW |title=Incidence, Predictors, and Outcomes of High-Grade Atrioventricular Block in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial) |journal=Am. J. Cardiol. |volume=119 |issue=9 |pages=1295–1301 |date=May 2017 |pmid=28267964 |doi=10.1016/j.amjcard.2017.01.019 |url=}}</ref> | * The prognosis of [[third degree heart block]] is most likely dependent on the [[patient]]'s underlying disease burden and severity of the [[clinical]] presentation on arrival.<ref name="pmid28267964">{{cite journal |vauthors=Kosmidou I, Redfors B, Dordi R, Dizon JM, McAndrew T, Mehran R, Ben-Yehuda O, Mintz GS, Stone GW |title=Incidence, Predictors, and Outcomes of High-Grade Atrioventricular Block in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial) |journal=Am. J. Cardiol. |volume=119 |issue=9 |pages=1295–1301 |date=May 2017 |pmid=28267964 |doi=10.1016/j.amjcard.2017.01.019 |url=}}</ref> | ||
*Complete heart block is sometimes reversible in settings such as [[acute MI]] by restoring [[Coronary circulation|coronary]] perfusion and in conditions such as [[Lymes disease|Lymes]] disease by treatment with [[antibiotics]].<ref name="pmid29759406">{{cite journal |vauthors=Harikrishnan P, Gupta T, Palaniswamy C, Kolte D, Khera S, Mujib M, Aronow WS, Ahn C, Sule S, Jain D, Ahmed A, Cooper HA, Jacobson J, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA |title=Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction: Temporal Trends and Association With In-Hospital Outcomes |journal=JACC Clin Electrophysiol |volume=1 |issue=6 |pages=529–538 |date=December 2015 |pmid=29759406 |doi=10.1016/j.jacep.2015.08.007 |url=}}</ref> | *Complete heart block is sometimes reversible in settings such as [[acute MI]] by restoring [[Coronary circulation|coronary]] perfusion and in conditions such as [[Lymes disease|Lymes]] disease by treatment with [[antibiotics]].<ref name="pmid29759406">{{cite journal |vauthors=Harikrishnan P, Gupta T, Palaniswamy C, Kolte D, Khera S, Mujib M, Aronow WS, Ahn C, Sule S, Jain D, Ahmed A, Cooper HA, Jacobson J, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA |title=Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction: Temporal Trends and Association With In-Hospital Outcomes |journal=JACC Clin Electrophysiol |volume=1 |issue=6 |pages=529–538 |date=December 2015 |pmid=29759406 |doi=10.1016/j.jacep.2015.08.007 |url=}}</ref> | ||
*Patients treated with permanent [[pacemaker]] have an excellent prognosis. | *[[Patients]] treated with permanent [[pacemaker]] have an excellent prognosis. | ||
* Patients with complete heart block due to [[acute myocardial infarction]] are at a greater risk for [[sudden cardiac death]]. | * [[Patients]] with [[complete heart block]] due to [[acute myocardial infarction]] are at a greater risk for [[sudden cardiac death]]. | ||
==References== | ==References== | ||
Latest revision as of 10:42, 30 June 2021
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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] Raviteja Guddeti, M.B.B.S. [3] ; Aditya Ganti M.B.B.S. [4]
Overview
The majority of the patients with complete heart block do not recover spontaneously. Untreated complete heart block is associated with high morbidity and mortality. Patients with complete heart blocks are prone to decreased perfusion related to symptomatic bradycardia and decreased cardiac output. Common Complications of third-degree AV block include sudden cardiac death due to asystole, syncope, and musculoskeletal injuries secondary to fall after syncope. The prognosis of the third-degree heart block is most likely dependent on the patient's underlying disease burden and severity of the clinical presentation on arrival. Patients treated with permanent pacemakers have an excellent prognosis.
Natural History, Complications, and Prognosis
Natural History
- Spontaneous recovery from third-degree heart block is very rare.
- The estimated overall mortality of non-paced patients with isolated AV block is 8%–16% in infants and 4%–8% in children and adults.[1][2]
- If left untreated, third-degree heart block is associated with high mortality which appears to occur as a consequence of the complications of prematurity and bradycardia owing to the delayed initiation of pacing therapy.
Complications
- Patients with complete heart block are susceptible to hypotension related to decreased cardiac output and bradycardia.[3]
- Patients with hemodynamic instability may be unable to protect their airway due to altered mental status leading to an aspiration that has high morbidity and mortality.
- Complications related to pace maker implantation include malposition or dislodgement of a pacemaker leads and cardiac perforation.
- Common complications of third degree AV block include:
- Sudden cardiac death due to asystole
- Syncope
- Musculoskeletal injuries secondary to fall after syncope.
- Cardiovascular collapse
- Hypotension
- Stokes-Adams syndrome
- Ventricular tachycardia[4][5]
- Ventricular fibrillation
- Worsening of heart failure
- Worsening of angina
- Death
Prognosis
- The prognosis of third degree heart block is most likely dependent on the patient's underlying disease burden and severity of the clinical presentation on arrival.[6]
- Complete heart block is sometimes reversible in settings such as acute MI by restoring coronary perfusion and in conditions such as Lymes disease by treatment with antibiotics.[7]
- Patients treated with permanent pacemaker have an excellent prognosis.
- Patients with complete heart block due to acute myocardial infarction are at a greater risk for sudden cardiac death.
References
- ↑ Proclemer A, Zecchin M, D'Onofrio A, Ricci RP, Boriani G, Rebellato L, Ghidina M, Bianco G, Bernardelli E, Miconi A, Zorzin AF, Gregori D (March 2019). "[The Pacemaker and Implantable Cardioverter-Defibrillator Registry of the Italian Association of Arrhythmology and Cardiac Pacing - Annual report 2017]". G Ital Cardiol (Rome) (in Italian). 20 (3): 136–148. doi:10.1714/3108.30963. PMID 30821295.
- ↑ Merchant FM, Hoskins MH, Musat DL, Prillinger JB, Roberts GJ, Nabutovsky Y, Mittal S (June 2017). "Incidence and Time Course for Developing Heart Failure With High-Burden Right Ventricular Pacing". Circ Cardiovasc Qual Outcomes. 10 (6). doi:10.1161/CIRCOUTCOMES.117.003564. PMID 28630373.
- ↑ Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO (January 2013). "2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. 127 (3): e283–352. doi:10.1161/CIR.0b013e318276ce9b. PMID 23255456.
- ↑ Strasberg B, Kusniec J, Erdman S, Lewin RF, Arditti A, Sclarovsky S, Agmon J (July 1986). "Polymorphous ventricular tachycardia and atrioventricular block". Pacing Clin Electrophysiol. 9 (4): 522–6. doi:10.1111/j.1540-8159.1986.tb06609.x. PMID 2426671.
- ↑ Tanaka Y, Yamabe H, Yamasaki H, Tsuda H, Nagayoshi Y, Kawano H, Kimura Y, Hokamura Y, Ogawa H (June 2009). "A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma". Pacing Clin Electrophysiol. 32 (6): 816–9. doi:10.1111/j.1540-8159.2009.02372.x. PMID 19545348.
- ↑ Kosmidou I, Redfors B, Dordi R, Dizon JM, McAndrew T, Mehran R, Ben-Yehuda O, Mintz GS, Stone GW (May 2017). "Incidence, Predictors, and Outcomes of High-Grade Atrioventricular Block in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (from the HORIZONS-AMI Trial)". Am. J. Cardiol. 119 (9): 1295–1301. doi:10.1016/j.amjcard.2017.01.019. PMID 28267964.
- ↑ Harikrishnan P, Gupta T, Palaniswamy C, Kolte D, Khera S, Mujib M, Aronow WS, Ahn C, Sule S, Jain D, Ahmed A, Cooper HA, Jacobson J, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA (December 2015). "Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction: Temporal Trends and Association With In-Hospital Outcomes". JACC Clin Electrophysiol. 1 (6): 529–538. doi:10.1016/j.jacep.2015.08.007. PMID 29759406.