Third degree AV block other diagnostic studies: Difference between revisions
| Line 45: | Line 45: | ||
* [[Carotid sinus massage]] is useful to determine the type of [[atrioventricular block]] When 2:1 [[atrioventricular block]] or Mobitz type I [[atrioventricular]] block in the setting of a [[wide QRS complex]] can not be differentiated on resting [[ECG]]. | * [[Carotid sinus massage]] is useful to determine the type of [[atrioventricular block]] When 2:1 [[atrioventricular block]] or Mobitz type I [[atrioventricular]] block in the setting of a [[wide QRS complex]] can not be differentiated on resting [[ECG]]. | ||
*Use of [[procainamide]] in [[patients]] with [[bifascicular block]] was associated with prolonged H-V interval indicating [[infranodal atrioventricular block]]. | *Use of [[procainamide]] in [[patients]] with [[bifascicular block]] was associated with prolonged H-V interval indicating [[infranodal atrioventricular block]]. | ||
Electrophysiologic studies (EPS) are rarely done to diagnose patients with complete AV block and may demonstrate:<ref>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</ref><ref>Kusumoto FM, Schoenfeld MH, Barrett C, et al. [https://doi.org/10.1016/j.jacc.2018.10.044 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</ref> | Electrophysiologic studies (EPS) are rarely done to diagnose patients with complete AV block and may demonstrate:<ref>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</ref><ref>Kusumoto FM, Schoenfeld MH, Barrett C, et al. [https://doi.org/10.1016/j.jacc.2018.10.044 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</ref> | ||
Revision as of 15:18, 20 June 2021
|
Third degree AV block Microchapters | |
|
Diagnosis | |
|---|---|
|
Treatment | |
|
Case Studies | |
|
Third degree AV block other diagnostic studies On the Web | |
|
American Roentgen Ray Society Images of Third degree AV block other diagnostic studies | |
|
Risk calculators and risk factors for Third degree AV block other diagnostic studies | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]
Overview
Other diagnostic studies for third-degree AV block include diagnostic electrophysiologic studies, which may demonstrate atrioventricular (AV) conduction abnormalities and help to determine the level of the block.Ambulatory monitoring is warranted in cases of possible transient heart block, or some other bradyarrhythmias that might be mistaken with third-degree AV block. Cardiac catheterization or stress testing is warranted if ischemic heart disease is suspected.
Other Diagnostic Studies
| Other diagnostic testing for bradycardia associated atrioventricular block |
| (Class IIa, Level of Evidence B): |
|
❑ambulatory electrocardiographic monitoring is recommended in the presence of first degree atrioventricular block or second degree atrioventricular block mobitz type 1 on ECG with symptoms of bradycardia (dizziness, faint) and unclear etiology, to establish correlation between symptoms and rhythm abnormalities. |
| (Class IIa, Level of Evidence C): |
|
❑Exercise treadmill test is recommended in the presence of chest pain or shortness of breath during exercise and first degree or second degree atrioventricular block during rest ECG |
| (Class IIb, Level of Evidence B): |
|
❑EPS is reasonable in second degree atrioventricular block for determining the level of block and benefit of PPM |
| (Class IIb, Level of Evidence C): |
|
❑ Carotid sinus massage or pharmacological challenge with atropine or isoproterenol, procainamide can be used in patients with second degree atrioventricular block to determine the level of block and the need for PPM insertion |
- Electrocardiographic monitoring can be used to identify the changes in QRS morphology such as alternating bundle branch block.
- Mobitz type1 atrioventricular block is much more associated with narrow QRS morphology and mobitz type 2 atrioventricular block usually has wide QRS morphology'
- In some cases, mobitz ttpe 1 atrioventricular block and narrow QRS complex contributes with infranodal atrioventricular block.
- Event monitors, worn for 30 to 90 days, and ICDs, which can be left in place for >2 years, tend to have greater diagnostic results than 24- to 48-hour ambulatory electrocardiographic monitoring.[1]
- Treadmill exercise stress testing can be used to identify the development of atrioventricular block and presence of ischemia as a precursor of atrioventricular block.[2]
- Treadmill exercise stress testing may be diagnostic to differentiate 2:1 atrioventricular block is Mobitz type I or II or identify the presence of infranodal disease.
- In the presence of bundle branch block or hemiblock on resting ECG, suspicion of episodic high-grade or complete atrioventricular block may raise.
- EPS may be helpful to determine the anatomic site of block in mobitz type 2 atrioventricular block including atrioventricular node, intra-His, or infra-His.
- The site of block In 70% of cases of 2:1 atrioventricular block with bundle branch block is infranodal block, however, 15% to 20% of these patients can have block in the atrioventricular node.
- EPS can also determine the bradycardia due to extrasystole which is similar to atrioventricular block on resting ECG.
- Carotid sinus massage is useful to determine the type of atrioventricular block When 2:1 atrioventricular block or Mobitz type I atrioventricular block in the setting of a wide QRS complex can not be differentiated on resting ECG.
- Use of procainamide in patients with bifascicular block was associated with prolonged H-V interval indicating infranodal atrioventricular block.
Electrophysiologic studies (EPS) are rarely done to diagnose patients with complete AV block and may demonstrate:[3][4]
- Atrioventricular (AV) conduction abnormalities
- Determining the level of the block (AV nodal or infranodal)
- Mapping, and providing basic material for intervention and placement of a pacemaker
Ambulatory monitoring is warranted in cases of:
- Transient heart block
- Other bradyarrhythmias that might be mistaken with third-degree AV block
Finally, if there are concerns for ischemic heart disease the cardiac catheterization or stress testing is warranted and might show:
- Pieces of evidence of active coronary ischemia
- Filling defect in the angiogram
- Positive stress test
References
- ↑ Shen WK, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW (August 2017). "2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society". Circulation. 136 (5): e60–e122. doi:10.1161/CIR.0000000000000499. PMID 28280231.
- ↑ Barold SS (November 2001). "Lingering misconceptions about type I second-degree atrioventricular block". Am J Cardiol. 88 (9): 1018–20. doi:10.1016/s0002-9149(01)01980-4. PMID 11703999.
- ↑ 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