Second degree AV block surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, M.D., Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
Overview
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.
Surgery
Mobitz I
Indications for implantation of a pacemaker include[1][2][3]:
- 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.
Mobitz II
- Type II Mobitz (symptomatic or asymptomatic) is by itself an indication for insertion of a pacemaker. Other indications include[4][5]:
- Myotonic dystrophy
- Kearns-Sayre syndrome
- Erb's dystrophy
- Peroneal muscular atrophy. These neuromuscular disorders have a high potential for unpredictable rapid progression to complete heart block.
- 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.
References
- ↑ Shigematsu-Locatelli M, Kawano T, Nishigaki A, Yamanaka D, Aoyama B, Tateiwa H, Kitaoka N, Yokoyama M (2017). "General anesthesia in a patient with asymptomatic second-degree two-to-one atrioventricular block". JA Clin Rep. 3 (1): 27. doi:10.1186/s40981-017-0099-0. PMC 5804611. PMID 29457071.
- ↑ Dhingra RC, Palileo E, Strasberg B, Swiryn S, Bauernfeind RA, Wyndham CR, Rosen KM (December 1981). "Significance of the HV interval in 517 patients with chronic bifascicular block". Circulation. 64 (6): 1265–71. doi:10.1161/01.cir.64.6.1265. PMID 7296798.
- ↑ Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Kirchhof P, Blomstrom-Lundqvist C, Badano LP, Aliyev F, Bänsch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM (August 2013). "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. 34 (29): 2281–329. doi:10.1093/eurheartj/eht150. PMID 23801822.
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD (August 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". J. Am. Coll. Cardiol. 74 (7): e51–e156. doi:10.1016/j.jacc.2018.10.044. PMID 30412709.
- ↑ Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM (May 1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–9. doi:10.1161/01.cir.63.5.1043. PMID 7471363.