Second degree AV block surgery
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If no reversible causes are present, definitive treatment of Mobitz type II second degree AV block involves permanent pacemaker placement in most patients. Dual-chamber pacing to maintain AV synchrony is preferred (rather than single chamber right ventricular pacing) in most patients due to the favorable hemodynamic benefits of AV synchrony. Unlike asymptomatic patients with Mobitz type I second degree AV block who do not require any specific therapy, patients with Mobitz type II second degree AV block have a high likelihood of progressing to symptomatic Mobitz type II second degree AV block or complete heart block and should be considered candidates for pacemaker insertion on initial presentation.
- Symptomatic bradycardia
- Heart failure
- Asystole for more than 3 sec
- Pseudopacemaker syndrome: Rarely second degree type I AV block can present with symptoms similar to pacemaker syndrome. In such cases placement of a pacemaker is warranted.
Dual chamber DDD pacing mode is usually employed in patients with Mobitz I and symptomatic bradycardia. This mode maintains the normal physiologic synchrony between the atria and the ventricles unlike the single chamber VVI mode.
- Type II Mobitz (symptomatic or asymptomatic) is by itself an indication for insertion of a pacemaker. Other indications include:
- Implantation of permanent pacemakers in both asymptomatic and symptomatic patients is usually done. Asymptomatic Mobitz II are prone to be converted to symptomatic or third degree heart block. Thus, they should be considered for a pacemaker even if asymptomatic.
- A dual chamber DDD pacemaker is preferred over a single chambered VVI pacemakers as it maintains physiologic AV synchrony.
- A dual-chamber artificial pacemaker is a type of device that typically listens for a pulse from the SA node and sends a pulse to the AV node at an appropriate interval, essentially completing the connection between the two nodes. Pacemakers in this role are usually programmed to enforce a minimum heart rate and to record instances of atrial flutter and atrial fibrillation.
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