Second degree AV block causes: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Second degree AV block}} | {{Second degree AV block}} | ||
{{CMG}}; {{AE}} {{CZ}} {{MS}} | {{CMG}}; {{AE}} {{CZ}}; {{MS}} | ||
==Overview== | ==Overview== | ||
Common causes of second degree [[AV block]] include acute [[myocardial ischemia]] or [[infarction]], [[infiltrative]] diseases, [[collagen vascular disease]], [[surgical trauma]], [[endocrine]] abnormalities, [[autonomic]] effects, [[neuromuscular ]] disorders, and [[medication]]s. | |||
==Causes== | ==Causes== | ||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated. | Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated<ref name="pmid29493981">{{cite journal |vauthors=Mangi MA, Jones WM, Napier L |title= |journal= |volume= |issue= |pages= |date= |pmid=29493981 |doi= |url=}}</ref>. | ||
* [[Acute myocardial infarction]] | * [[Acute myocardial infarction]]<ref name="pmid30227965">{{cite journal |vauthors=Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM, Elayi CS |title=Frequency and Significance of High-Degree Atrioventricular Block and Sinoatrial Node Dysfunction in Patients With Non-ST-Elevation Myocardial Infarction |journal=Am. J. Cardiol. |volume=122 |issue=10 |pages=1598–1603 |date=November 2018 |pmid=30227965 |doi=10.1016/j.amjcard.2018.08.001 |url=}}</ref><ref name="pmid23224264">{{cite journal |vauthors=Barold SS, Herweg B |title=Second-degree atrioventricular block revisited |journal=Herzschrittmacherther Elektrophysiol |volume=23 |issue=4 |pages=296–304 |date=December 2012 |pmid=23224264 |doi=10.1007/s00399-012-0240-8 |url=}}</ref> | ||
* [[Acute rheumatic fever]] | * [[Acute rheumatic fever]] | ||
* [[Bacterial endocarditis]] | * [[Bacterial endocarditis]] | ||
* [[Myocarditis]] | * [[Myocarditis]] | ||
* [[hypothermia|Severe hypothermia]] | |||
===Common Causes=== | ===Common Causes=== | ||
* [[Acute rheumatic fever]] | * [[Acute rheumatic fever]] | ||
* [[Bacterial endocarditis]]<ref name="pmid27585419">{{cite journal |vauthors=Kamatani T, Akizuki A, Kondo S, Shirota T |title=Second-Degree Atrioventricular Block Occurring After Tooth Extraction |journal=Anesth Prog |volume=63 |issue=3 |pages=156–9 |date=Fall 2016 |pmid=27585419 |pmc=5011958 |doi=10.2344/15-00042.1 |url=}}</ref> | |||
* [[Bacterial endocarditis]], | |||
* [[aortic stenosis|Calcific aortic stenosis]] | * [[aortic stenosis|Calcific aortic stenosis]] | ||
* [[Digoxin]] | * [[Digoxin]] | ||
* [[Dilated cardiomyopathy]] | * [[Dilated cardiomyopathy]] | ||
* [[Diltiazem]] | * [[Diltiazem]] | ||
* [[ | * [[Vasovagal syncope#Cardioinhibitory Response|Enhanced vagal tone]] | ||
* [[HCM]] | * [[HCM]] | ||
* [[Hypertension]] | * [[Hypertension]] | ||
* Iatrogenic after correction of [[VSD]], [[tetralogy of Fallot]], and [[endocardial cushion defect]] | * [[Iatrogenic]] after surgical correction of [[VSD]], [[tetralogy of Fallot]], and [[endocardial cushion defect]] | ||
* | * [[ST elevation MI|Inferior ST elevation MI]] | ||
* [[mitral valve sclerosis|Massive calcification of the mitral annulus]] | * [[mitral valve sclerosis|Massive calcification of the mitral annulus]] | ||
* [[ | * [[Myocarditis]] | ||
* Normal variants | * [[PR interval|Normal variants]]<ref name="pmid8445186">{{cite journal |vauthors=Wogan JM, Lowenstein SR, Gordon GS |title=Second-degree atrioventricular block: Mobitz type II |journal=J Emerg Med |volume=11 |issue=1 |pages=47–54 |date=1993 |pmid=8445186 |doi=10.1016/0736-4679(93)90009-v |url=}}</ref> | ||
* [[chest trauma|Penetrating and non-penetrating trauma of the chest]] | * [[chest trauma|Penetrating and non-penetrating trauma of the chest]] | ||
* [[ | * [[Lev's disease|Sclerodegenerative disease of the electrical conduction system]] | ||
* [[Verapamil]] | |||
* [[ | * [[Beta blocker|β blockers]] | ||
* [[ | |||
===Causes by Organ System=== | ===Causes by Organ System=== | ||
{|style="width:80%; height:100px" border="1" | {|style="width:80%; height:100px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | | |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute myocardial infarction]], [[acute rheumatic fever]], [[ASD]], [[dilated cardiomyopathy]], [[Ebstein's anomaly]], [[Carotid sinus hypersensitivity|hypersensitive carotid sinus syndrome]], [[hypertension]], [[hypertrophic cardiomyopathy]], [[Lev's disease]], [[myocardial bridging]], [[myocarditis]], [[PR interval|normal variants]], [[Aortic valve replacement|post aortic valve replacement]], [[catheter ablation|post catheter ablation for arrhythmias]], [[ventricular septal defect surgery|post closure of a ventricular septal defect]], [[mitral valve replacement|post mitral valve replacement]], [[tetralogy of Fallot]], [[endocardial cushion defect]], [[transposition of the great vessels]], [[valvular heart disease]], [[VSD]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''Drug Side Effect''' | ||
|bgcolor="Beige"| [[ | |bgcolor="Beige"| [[Amiodarone]], [[beta-blockers]], [[digitalis]], [[calcium channel blockers]], [[cholinesterase inhibitor|cholinesterase inhibitors]], [[disopyramide]], [[dofetilide]], [[dolasetron]], [[donepezil]], [[eslicarbazepine acetate]], [[fesoterodine]], [[fingolimod]], [[flecainide]], [[ibutilide]], [[lacosamide]], [[magnesium]], [[paliperidone]], [[pramipexole]], [[procainamide]], [[propafenone]], [[propoxyphene]], [[quinidine]], [[sotalol]], [[terodiline]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Endocrine''' | | '''Endocrine''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Hyperthyroidism]], [[myxedema]], [[periodic paralysis|thyrotoxic periodic paralysis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Environmental''' | | '''Environmental''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Hypothermia]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Genetic''' | | '''Genetic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Emery-Dreifuss muscular dystrophy]], [[Fabry disease]], [[glycogenosis type 2b]], [[Neuromuscular disease|hereditary neuromuscular disease]], [[Kearns-Sayre syndrome]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Hematologic''' | | '''Hematologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Multiple myeloma]] [[Lymphoma]]<ref name="pmid27200273">{{cite journal |vauthors=Menicagli F, Lanza A, Sbrocca F, Baldi A, Spugnini EP |title=A case of advanced second-degree atrioventricular block in a ferret secondary to lymphoma |journal=Open Vet J |volume=6 |issue=1 |pages=68–70 |date=2016 |pmid=27200273 |pmc=4833871 |doi=10.4314/ovj.v6i1.10 |url=}}</ref> | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Iatrogenic''' | | '''Iatrogenic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[aortic valve replacement|Post aortic valve replacement]], [[catheter ablation|post catheter ablation for arrhythmias]], [[ventricular septal defect surgery|post closure of a ventricular septal defect]], [[mitral valve replacement|post mitral valve replacement]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Infectious Disease''' | | '''Infectious Disease''' | ||
|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[ | |bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[diphtheria]], [[Lyme disease]], [[myocarditis]], [[neonatal lupus erythematosus]], [[protozoa|protozoal infection]], [[sarcoidosis]], [[SLE]], [[tuberculosis]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal / Ortho''' | | '''Musculoskeletal / Ortho''' | ||
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[ | |bgcolor="Beige"| [[Ankylosing spondylitis]], [[Neuromuscular disease|hereditary neuromuscular disease]], [[Kearns-Sayre syndrome]], [[mitochondrial DNA|mitochondrial genome inherited conditions]], [[muscular dystrophy]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Neurologic''' | | '''Neurologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Vasovagal syncope#Cardioinhibitory Response|Enhanced vagal tone]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Nutritional / Metabolic''' | | '''Nutritional / Metabolic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Fabry disease]], [[glycogenosis type 2b]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Oncologic''' | | '''Oncologic''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Multiple myeloma]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| ''' | | '''Opthalmologic''' | ||
|bgcolor="Beige"| No underlying causes | |bgcolor="Beige"| No underlying causes | ||
|- | |- | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Renal / Electrolyte''' | | '''Renal / Electrolyte''' | ||
|bgcolor="Beige"| | |bgcolor="Beige"| [[Hyperkalemia]], [[hypokalemia]] | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Rheum / Immune / Allergy''' | | '''Rheum / Immune / Allergy''' | ||
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[ | |bgcolor="Beige"| [[Ankylosing spondylitis]], [[dermatomyositis]], [[rheumatoid arthritis]], [[scleroderma]], [[SLE]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Miscellaneous''' | | '''Miscellaneous''' | ||
|bgcolor="Beige"| [[Amyloidosis]], | |bgcolor="Beige"| [[Amyloidosis]], [[degenerative diseases]] | ||
|- | |- | ||
|} | |} | ||
===Causes in Alphabetical Order=== | ===Causes in Alphabetical Order=== | ||
* | {{col-begin|width=80%}} | ||
*[[Acute rheumatic fever]] | {{col-break|width=33%}} | ||
*[[Amyloidosis]] | * [[Acute myocardial infarction]] | ||
*[[Ankylosing spondylitis]] | * [[Acute rheumatic fever]] | ||
*[[ASD]] | * [[Amyloidosis]] | ||
* | * [[Ankylosing spondylitis]] | ||
*[[Beta- | * [[ASD]] | ||
*[[Calcium channel | * [[Bacterial endocarditis]] | ||
*[[Cardiac glycosides]] | * [[Beta-blockers]] | ||
*[[Chagas disease]] | * [[Calcific aortic stenosis]] | ||
*[[Cholinesterase | * [[Calcium channel blockers]] | ||
*[[Dermatomyositis]] | * [[Cardiac glycosides]] | ||
*[[Digitalis]] | * [[Cardiac tumors]] | ||
*[[Dilated cardiomyopathy]] | * [[Chagas disease]] | ||
*[[Diphtheria]] | * [[Cholinesterase inhibitors]] | ||
*[[Ebstein's anomaly]] | * [[Clonidine]] | ||
*[[ | * [[Degenerative diseases]] | ||
*Enhanced vagal tone | * [[Dermatomyositis]] | ||
*[[HCM]] | * [[Digitalis]] | ||
*[[ | * [[Digoxin]] | ||
*[[ | * [[Dilated cardiomyopathy]] | ||
*[[Lyme disease]] | * [[Diltiazem]] | ||
*[[Muscular dystrophy]] | * [[Diphtheria]] | ||
*[[Myocarditis]] | * [[Disopyramide]] | ||
*Normal variants | * [[Dolasetron]] | ||
*[[Procainamide]] | * [[Donepezil]] | ||
*[[Quinidine]] | * [[Ebstein's anomaly]] | ||
*[[Sarcoidosis]] | * [[Electrolyte disturbances]] | ||
*[[ | * [[Emery-Dreifuss muscular dystrophy]] | ||
*[[ | * [[Endocarditis]] | ||
*[[Tetralogy of Fallot]] | * [[vagus nerve|Enhanced vagal tone in athletes]] | ||
*[[Transposition of the great vessels]] | {{col-break|width=33%}} | ||
*[[Valvular heart disease]] | * [[Eslicarbazepine acetate]] | ||
*[[VSD]] | * [[Fabry disease]] | ||
* [[Fesoterodine]] | |||
* [[Fingolimod]] | |||
* [[Glycogenosis type 2b]] | |||
* [[HCM]] | |||
* [[Neuromuscular disease|Hereditary neuromuscular disease]] | |||
* [[Hodgkin lymphoma]] | |||
* [[Hyperkalaemia]] | |||
* [[Carotid sinus hypersensitivity|Hypersensitive carotid sinus syndrome]] | |||
* [[Hyperthyroidism]] | |||
* [[Hypokalaemia]] | |||
* [[Hypothermia]] | |||
* [[Ibutilide]] | |||
* [[Ischemic heart disease]] | |||
* [[Kearns-Sayre syndrome]] | |||
* [[Labetalol]] | |||
* [[Lacosamide]] | |||
* [[Lanatoside C]] | |||
* [[Lenegre's disease]] | |||
* [[Lev's disease]] | |||
* [[Lyme disease]] | |||
* [[Mitochondrial DNA|Mitochondrial genome inherited conditions]] | |||
* [[Multiple myeloma]] | |||
* [[Muscular dystrophy]] | |||
* [[Myocardial bridging]] | |||
* [[Myocarditis]] | |||
* [[Myotonic dystrophy]] | |||
* [[Myxedema]] | |||
{{col-break|width=33%}} | |||
* [[Neonatal lupus erythematosus]] | |||
* [[prolonged PR interval|Normal variants of PR prolongation]] | |||
* [[Paliperidone]] | |||
* [[aortic valve replacement|Post aortic valve replacement]] | |||
* [[catheter ablation|Post catheter ablation for arrhythmias]] | |||
* [[Ventricular septal defect surgery|Post closure of a ventricular septal defect]] | |||
* [[mitral valve replacement|Post mitral valve replacement]] | |||
* [[Procainamide]] | |||
* [[Propoxyphene]] | |||
* [[Propranolol]] | |||
* [[Protozoa|Protozoal infection]] | |||
* [[Quinidine]] | |||
* [[Quinine]] | |||
* [[Rheumatic fever|Rheumatic mitral valve disease]] | |||
* [[Sarcoidosis]] | |||
* [[SLE]] | |||
* [[Systemic sclerosis]] | |||
* [[Terodiline]] | |||
* [[Tetralogy of Fallot]] | |||
* [[periodic paralysis|Thyrotoxic periodic paralysis]] | |||
* [[Tolterodine]] | |||
* [[Transposition of the great vessels]] | |||
* [[vagus nerve|Vagal maneuvers]] | |||
* [[Valsalva maneuvers]] | |||
* [[Valvular heart disease]] | |||
* [[Verapamil]] | |||
* [[VSD]] | |||
* [[sex linkage|X-linked inherited conditions]] | |||
{{col-end}} | |||
===Contraindicated medications=== | |||
{{MedCondContrAbs | |||
|MedCond = Second degree AV block (except in [[patients]] with a functioning artificial [[pacemaker]])<ref name="pmid26115830">{{cite journal |vauthors=Brignole M, Deharo JC, Guieu R |title=Syncope and Idiopathic (Paroxysmal) AV Block |journal=Cardiol Clin |volume=33 |issue=3 |pages=441–7 |date=August 2015 |pmid=26115830 |doi=10.1016/j.ccl.2015.04.012 |url=}}</ref><ref name="pmid11229299">{{cite journal |vauthors=Kelkar PN |title=Atenolol induced high grade AV block |journal=J Assoc Physicians India |volume=46 |issue=8 |pages=748, 751 |date=August 1998 |pmid=11229299 |doi= |url=}}</ref>|Adenosine|Atenolol|Betaxolol|Bisoprolol|Brimonidine tartrate and Timolol maleate|Carteolol|Diltiazem|Disopyramide|Dronedarone|Fingolimod|Flecainide|Metoprolol|Mexiletine|Nadolol|Nebivolol|Penbutolol|Pindolol|Propranolol|Sotalol|Timolol|Labetalol}}<ref name="pmid15234417">{{cite journal |vauthors=Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M, Viskin S |title=Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug |journal=J. Am. Coll. Cardiol. |volume=44 |issue=1 |pages=105–8 |date=July 2004 |pmid=15234417 |doi=10.1016/j.jacc.2004.03.057 |url=}}</ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Up-To-Date cardiology]] | [[Category:Up-To-Date cardiology]] | ||
[[Category:Arrhythmia]] | [[Category:Arrhythmia]] | ||
[[Category:Electrophysiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
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Latest revision as of 05:40, 12 July 2021
Second degree AV block Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Mahmoud Sakr, M.D. [3]
Overview
Common causes of second degree AV block include acute myocardial ischemia or infarction, infiltrative diseases, collagen vascular disease, surgical trauma, endocrine abnormalities, autonomic effects, neuromuscular disorders, and medications.
Causes
Life Threatening Causes
Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated[1].
- Acute myocardial infarction[2][3]
- Acute rheumatic fever
- Bacterial endocarditis
- Myocarditis
- Severe hypothermia
Common Causes
- Acute rheumatic fever
- Bacterial endocarditis[4]
- Calcific aortic stenosis
- Digoxin
- Dilated cardiomyopathy
- Diltiazem
- Enhanced vagal tone
- HCM
- Hypertension
- Iatrogenic after surgical correction of VSD, tetralogy of Fallot, and endocardial cushion defect
- Inferior ST elevation MI
- Massive calcification of the mitral annulus
- Myocarditis
- Normal variants[5]
- Penetrating and non-penetrating trauma of the chest
- Sclerodegenerative disease of the electrical conduction system
- Verapamil
- β blockers
Causes by Organ System
Causes in Alphabetical Order
Contraindicated medications
Second degree AV block (except in patients with a functioning artificial pacemaker)[7][8] is considered an absolute contraindication to the use of the following medications:
- Adenosine
- Atenolol
- Betaxolol
- Bisoprolol
- Brimonidine tartrate and Timolol maleate
- Carteolol
- Diltiazem
- Disopyramide
- Dronedarone
- Flecainide
- Metoprolol
- Mexiletine
- Nadolol
- Nebivolol
- Penbutolol
- Pindolol
- Propranolol
- Sotalol
- Timolol
- Labetalol[9]
References
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=
(help) - ↑ Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM, Elayi CS (November 2018). "Frequency and Significance of High-Degree Atrioventricular Block and Sinoatrial Node Dysfunction in Patients With Non-ST-Elevation Myocardial Infarction". Am. J. Cardiol. 122 (10): 1598–1603. doi:10.1016/j.amjcard.2018.08.001. PMID 30227965.
- ↑ Barold SS, Herweg B (December 2012). "Second-degree atrioventricular block revisited". Herzschrittmacherther Elektrophysiol. 23 (4): 296–304. doi:10.1007/s00399-012-0240-8. PMID 23224264.
- ↑ Kamatani T, Akizuki A, Kondo S, Shirota T (Fall 2016). "Second-Degree Atrioventricular Block Occurring After Tooth Extraction". Anesth Prog. 63 (3): 156–9. doi:10.2344/15-00042.1. PMC 5011958. PMID 27585419.
- ↑ Wogan JM, Lowenstein SR, Gordon GS (1993). "Second-degree atrioventricular block: Mobitz type II". J Emerg Med. 11 (1): 47–54. doi:10.1016/0736-4679(93)90009-v. PMID 8445186.
- ↑ Menicagli F, Lanza A, Sbrocca F, Baldi A, Spugnini EP (2016). "A case of advanced second-degree atrioventricular block in a ferret secondary to lymphoma". Open Vet J. 6 (1): 68–70. doi:10.4314/ovj.v6i1.10. PMC 4833871. PMID 27200273.
- ↑ Brignole M, Deharo JC, Guieu R (August 2015). "Syncope and Idiopathic (Paroxysmal) AV Block". Cardiol Clin. 33 (3): 441–7. doi:10.1016/j.ccl.2015.04.012. PMID 26115830.
- ↑ Kelkar PN (August 1998). "Atenolol induced high grade AV block". J Assoc Physicians India. 46 (8): 748, 751. PMID 11229299.
- ↑ Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M, Viskin S (July 2004). "Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug". J. Am. Coll. Cardiol. 44 (1): 105–8. doi:10.1016/j.jacc.2004.03.057. PMID 15234417.