Second degree AV block primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Effective measures for primary prevention of atrioventricular block include treatment of hypertension and maintenance of normal blood glucose levels. Atrioventricular (AV) block is a common reason for pacemaker implantation, and the number of pacemaker implantations is increasing. Atrioventricular block most commonly occurs in the absence of significant cardiac disease and is generally attributed to idiopathic fibrosis of the conduction system. By definition, the cause of that fibrosis remains unknown without primary prevention strategy.
Primary prevention
- Pacemaker implantations as a treatment for atrioventricular (AV) block are increasing worldwide. Prevention strategies for AV block are lacking because modifiable risk factors have not yet been identified[1][2][3].
- Pacemakers can usually provide adequate treatment of the symptoms of AV block, no preventive or curative strategies are currently used in clinical practice.
- Pacemaker implantation can involve a risk of serious complications, such as pneumothorax, cardiac tamponade, and death.[4].
- After implantation, patients require generator changes, which carry a particularly high risk of infection and resultant endocarditis.[5].
- Finally, independent of these procedural complications, successful pacemaker therapy has been associated with a worse prognosis.[6][7].
- A better understanding of the conditions associated with severe AV conduction disease would enable the development of prevention strategies, ideally avoiding the pacemaker-associated complications and increased use of health care resources[8].
- No previous study, to our knowledge, has reported the population-based characteristics associated with incident AV block.
- Atrioventricular block is associated with multiple known cardiovascular risk factors and conditions.
- Modifiable risk factors of elevated systolic blood pressure and a higher fasting glucose level were independently associated with AV block.
- Taken together, these 2 directly modifiable variables potentially explain more than half of allAV blocks in a community-based population.[9].
- Effective treatment of hypertension and maintenance of normal blood glucose levels may be useful strategies in preventing AV block.
References
- ↑ Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, Kenttä TV, Rissanen H, Vittinghoff E, Knekt P, Heliövaara M, Huikuri HV, Marcus GM (May 2019). "Risk Factors Associated With Atrioventricular Block". JAMA Netw Open. 2 (5): e194176. doi:10.1001/jamanetworkopen.2019.4176. PMC 6632153 Check
|pmc=value (help). PMID 31125096. - ↑ Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M, Budaj A, Pais P, Varigos J, Lisheng L (2004). "Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study". Lancet. 364 (9438): 937–52. doi:10.1016/S0140-6736(04)17018-9. PMID 15364185.
- ↑ LEV M (November 1964). "ANATOMIC BASIS FOR ATRIOVENTRICULAR BLOCK". Am. J. Med. 37: 742–8. doi:10.1016/0002-9343(64)90022-1. PMID 14237429.
- ↑ Pfeiffer D, Jung W, Fehske W, Korte T, Manz M, Moosdorf R, Lüderitz B (April 1994). "Complications of pacemaker-defibrillator devices: diagnosis and management". Am. Heart J. 127 (4 Pt 2): 1073–80. doi:10.1016/0002-8703(94)90090-6. PMID 8160583.
- ↑ Bloom H, Heeke B, Leon A, Mera F, Delurgio D, Beshai J, Langberg J (February 2006). "Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery". Pacing Clin Electrophysiol. 29 (2): 142–5. doi:10.1111/j.1540-8159.2006.00307.x. PMID 16492298.
- ↑ Gang UJ, Hvelplund A, Pedersen S, Iversen A, Jøns C, Abildstrøm SZ, Haarbo J, Jensen JS, Thomsen PE (November 2012). "High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention". Europace. 14 (11): 1639–45. doi:10.1093/europace/eus161. PMID 22645234.
- ↑ Simon AB, Zloto AE (March 1978). "Atrioventricular block: natural history after permanent ventricular pacing". Am. J. Cardiol. 41 (3): 500–7. doi:10.1016/0002-9149(78)90006-1. PMID 626128.
- ↑ Bradshaw PJ, Stobie P, Knuiman MW, Briffa TG, Hobbs MS (2015). "Life expectancy after implantation of a first cardiac permanent pacemaker (1995-2008): A population-based study". Int. J. Cardiol. 190: 42–6. doi:10.1016/j.ijcard.2015.04.099. PMID 25912118.
- ↑ 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 (June 2008). "ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary". Heart Rhythm. 5 (6): 934–55. doi:10.1016/j.hrthm.2008.04.015. PMID 18534377.