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{{Third degree AV block}}
{{Third degree AV block}}
{{CMG}} {{AE}} {{Soroush}}
{{CMG}} {{AE}} {{Sara.Zand}} {{Soroush}}
==Overview==
==Overview==
Nuclear imaging techniques might rarely used and may be helpful in the diagnosis of complications of third degree AV block or provide shreds of evidence in favor of the underlying disease in those with compete heart block.  
[[Determination]] the underlying [[cardiac]] or non-[[cardiac]] cause of [[bradycardia]] or [[conduction disorder]] has prognostic value. When the [[structural heart disease]] can not be identified by [[echocardiography]], advanced imaging  including [[TEE]], [[cardiac computed tomography]], [[cardiac MRI]] may be helpful in selected [[patients]].


==Other Imaging Findings==
==Other Imaging Findings==
Nuclear imaging techniques might rarely be used and may be helpful in the diagnosis of complications of [[third degree AV block ]] or provide shreds of evidence in favor of the underlying disease in those with [[complete heart block]]. Imaging modalities might include:
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
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| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendation for cardiac imaging for management of bradycardia associated atrioventricular block'''
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|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Transthoracic echocardiography]] ([[ACC AHA guidelines classification scheme|Class I , Level of Evidence B]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑[[Transthoracic echocardiography]] is recommended in [[patients]] with newly identified [[LBBB]], [[Second-degree mobitz type 2 AV block]], [[high grade AV block]], [[third-degree AV block]] with or without diagnosed [[structural heart disease]] or [[coronary artery disease]]<br> <br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' [[Transthoracic echocardiography]] ([[ACC AHA guidelines classification scheme|Class IIa , Level of Evidence B]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[Transthoracic echocardiography]] is reasonable in [[patients]] with [[bradycardia]] or conduction disorder other than [[LBBB]], [[Second-degree mobitz type2 AV block]], [[high grade AV block]], [[third-degree AV block]] in suspicion of [[structural heart disease]] <br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Advanced imaging]] ([[ACC AHA guidelines classification scheme|Class IIa , Level of Evidence C]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑  [[Transesophageal echocardiography]], [[computed tomography]], [[cardiac magnetic resonance]] is recommended for  [[patients]] with [[bradycardia]] or [[bundle branch block]] in suspicion of [[structural heart disease]] undiagnosed by other [[modalities]]<br>
|-


*Accurate [[ejection fraction] measurement by means of [[nuclear]] medicine
<br>
*[[PET scan]] to diagnose hidden [[infection]] or [[malignancy]]
|}
*Finally, if there are concerns for [[ischemic heart disease]], nuclear medicine stress testing might be helpful and may show pieces of evidence of [[coronary]] [[ischemia]] during [[exercise]]/chemical [[stress test]].
<br>
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2018 AHA/ACC/HRS Guideline<ref name="KusumotoSchoenfeld2019">{{cite journal|last1=Kusumoto|first1=Fred M.|last2=Schoenfeld|first2=Mark H.|last3=Barrett|first3=Coletta|last4=Edgerton|first4=James R.|last5=Ellenbogen|first5=Kenneth A.|last6=Gold|first6=Michael R.|last7=Goldschlager|first7=Nora F.|last8=Hamilton|first8=Robert M.|last9=Joglar|first9=José A.|last10=Kim|first10=Robert J.|last11=Lee|first11=Richard|last12=Marine|first12=Joseph E.|last13=McLeod|first13=Christopher J.|last14=Oken|first14=Keith R.|last15=Patton|first15=Kristen K.|last16=Pellegrini|first16=Cara N.|last17=Selzman|first17=Kimberly A.|last18=Thompson|first18=Annemarie|last19=Varosy|first19=Paul D.|title=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|journal=Circulation|volume=140|issue=8|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000628}}</ref>
|-
|}


==References==
==References==

Latest revision as of 11:54, 25 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Soroush Seifirad, M.D.[3]

Overview

Determination the underlying cardiac or non-cardiac cause of bradycardia or conduction disorder has prognostic value. When the structural heart disease can not be identified by echocardiography, advanced imaging including TEE, cardiac computed tomography, cardiac MRI may be helpful in selected patients.

Other Imaging Findings


Recommendation for cardiac imaging for management of bradycardia associated atrioventricular block
Transthoracic echocardiography (Class I , Level of Evidence B):

❑Transthoracic echocardiography is recommended in patients with newly identified LBBB, Second-degree mobitz type 2 AV block, high grade AV block, third-degree AV block with or without diagnosed structural heart disease or coronary artery disease

Transthoracic echocardiography (Class IIa , Level of Evidence B):

❑ Transthoracic echocardiography is reasonable in patients with bradycardia or conduction disorder other than LBBB, Second-degree mobitz type2 AV block, high grade AV block, third-degree AV block in suspicion of structural heart disease

Advanced imaging (Class IIa , Level of Evidence C):

❑ Transesophageal echocardiography, computed tomography, cardiac magnetic resonance is recommended for patients with bradycardia or bundle branch block in suspicion of structural heart disease undiagnosed by other modalities


The above table adopted from 2018 AHA/ACC/HRS Guideline[1]

References

  1. ↑ Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). "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". Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.


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