Third degree AV block natural history, complications and prognosis: Difference between revisions
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===Complications=== | ===Complications=== | ||
* Patients with third-degree heart blocks are vulnerable to [[Perfusion|decreased perfusion]] related to symptomatic [[bradycardia]] and [[Cardiac output|decreased cardiac output]]. | * Patients with third-degree heart blocks are vulnerable to [[Perfusion|decreased perfusion]] related to symptomatic [[bradycardia]] and [[Cardiac output|decreased cardiac output]].<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> | ||
* Critically ill patients may be unable to protect their airway and may develop [[nausea]], possibly [[aspirate]], and may have [[delirium]]. | * Critically ill patients may be unable to protect their airway and may develop [[nausea]], possibly [[aspirate]], and may have [[delirium]]. | ||
* Treatment-related complications in the short term are malposition or dislodgement of a [[pacemaker]] lead and [[Perforation|cardiac perforation]] in the short term and pacemaker associated [[heart failure]] in the long term. | * Treatment-related complications in the short term are malposition or dislodgement of a [[pacemaker]] lead and [[Perforation|cardiac perforation]] in the short term and pacemaker associated [[heart failure]] in the long term. | ||
Revision as of 03:47, 11 April 2020
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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]
Overview
Spontaneous recovery from third degree heart block is very rare. If left untreated third degree heart block is associated with a high mortality which appears to occur as a consequence of the complications of prematurity and bradycardia owing to the delayed initiation of pacing therapy. Patients with third-degree heart blocks are vulnerable 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.
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.
- If left untreated third degree heart block is associated with a 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 third-degree heart blocks are vulnerable to decreased perfusion related to symptomatic bradycardia and decreased cardiac output.[1]
- Critically ill patients may be unable to protect their airway and may develop nausea, possibly aspirate, and may have delirium.
- Treatment-related complications in the short term are malposition or dislodgement of a pacemaker lead and cardiac perforation in the short term and pacemaker associated heart failure in the long term.
- 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
- 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.[2]
- 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.[3]
- 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
- ↑ 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.
- ↑ 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.