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{{Third degree AV block}}
{{Third degree AV block}}
{{CMG}}; {{AE}} {{Soroush}}
{{CMG}}; {{AE}} {{Soroush}} [[User:Qasim Khurshid|Qasim Khurshid, M.B.B.S [3]]].
== Overview ==
== Overview ==
A 12-lead [[The electrocardiogram|Electrocardiography (ECG)]]  is the gold standard test for the diagnosis of [[third degree AV block]]. Nevertheless, it might be normal in [[patients]] with [[transient]] [[AV block]]. A [[Holter monitoring]] and/or [[Telemetry unit|telemetry]] must be performed when the patient presents with [[signs]] and [[symptoms]] which raising concern for [[complete heart block]] in the presence of a normal [[ECG]]. Diagnostic [[electrophysiologic studies]] might be used in certain complicated cases


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
The [[The electrocardiogram|Electrocardiogram (ECG)]] is the gold standard test for the diagnosis of third degree AV block.  
A 12-lead [[The electrocardiogram|Electrocardiography (ECG)]] is the [[gold standard]] test for the diagnosis of [[third degree AV block]].  


Nevertheless, it might be normal in patients with transient AV block.
Nevertheless, it might be normal in [[patients]] with [[transient AV block]].


A Holter monitoring and/or telemetry must be performed when:
A [[Holter monitoring]] and/or [[telemetry]] must be performed when a [[patient]] presents with [[sign]] and [[symptoms]] which raising concern for transient [[complete heart block]] such as:


* The patient presents with sign and symptoms which raising concern for complete heart block such as:
:*[[Syncope]]
*Syncope
:*History of [[Heart]] [[disease]]
*History of Heart disease
:*[[Elderly]]
*Risk factors of Heart disease
:*History of taking [[AV blocking]] agents  
*Elderly
:*History of [[heart surgery]]
*History of AV blocking agents in heir manuscript
*History of heart surgery


 
*[[Patients]] with third-degree AV block will have evidence of P wave and [[QRS complexes]] that are independent of each other.
Investigations:
* In the majority of the cases, the [[atrial rate]] will be faster than the [[ventricular escape]] rate, and there will be no association between the [[P waves]] and [[QRS complexes]].
* Among the patients who present with clinical signs of third degree AV block, the [investigation name] is the most specific test for the diagnosis.
* With a very few exceptions, [[Electrophysiologic studies|electrophysiologic]] studies  are not necessary in [[patients]] with [[Third degree AV block|complete AV block]].<ref>Brignole M, Auricchio A, Baron-Esquivias G, et al. [https://doi.org/10.1093/eurheartj/eht150 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>
* Among the patients who present with clinical signs of third degree AV block, the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of third degree AV block, the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for third degree AV block ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for third degree AV block:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
third degree AV block is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of third degree AV block.
 
OR
 
There is no single diagnostic study of choice for third degree AV block, though third degree AV block may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of third degree AV block is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of third degree AV block is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
third degree AV block may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of third degree AV block is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of third degree AV block is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of third degree AV block is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of third degree AV block.


==References==
==References==

Latest revision as of 19:16, 13 June 2021

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

Overview

A 12-lead Electrocardiography (ECG) is the gold standard test for the diagnosis of third degree AV block. Nevertheless, it might be normal in patients with transient AV block. A Holter monitoring and/or telemetry must be performed when the patient presents with signs and symptoms which raising concern for complete heart block in the presence of a normal ECG. Diagnostic electrophysiologic studies might be used in certain complicated cases

Diagnostic Study of Choice

Study of choice

A 12-lead Electrocardiography (ECG) is the gold standard test for the diagnosis of third degree AV block.

Nevertheless, it might be normal in patients with transient AV block.

A Holter monitoring and/or telemetry must be performed when a patient presents with sign and symptoms which raising concern for transient complete heart block such as:

References

  1. ↑ 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
  2. ↑ 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

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