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__NOTOC__
__NOTOC__
{{Third degree AV block}}
{{Third degree AV block}}
{{CMG}}; {{AE}} {{Soroush}} {{ADG}}
{{CMG}}; {{AE}} {{Sara.Zand}} {{Soroush}} {{ADG}}
==Overview==
==Overview==


There is insufficient evidence to recommend routine screening for third degree AV block. However, screening for congenital AV block is recommended.  
[[Ambulatory electrocardiographic monitoring]] is useful for finding intermittent  [[atrioventricular block]], [[LBBB]] and [[bifascicular block]] in [[asymptomatic]] [[patients]]. In [[patients]] with [[symptomatic]] [[atrioventricular block]] or [[bradycardia]] during [[sleep]], screening about [[sleep apnea]] is recommended.
 
==Screening==
==Screening==
*[[Ambulatory electrocardiographic monitoring]] is useful for finding intermittent  [[atrioventricular block]], [[LBBB]] and [[bifascicular block]] in [[asymptomatic]] [[patients]].
* In [[patients]] with [[symptomatic]] [[atrioventricular block]] or [[bradycardia]] during [[sleep]], screening about [[sleep apnea]] is recommended.<ref name="KasaiFloras2012">{{cite journal|last1=Kasai|first1=Takatoshi|last2=Floras|first2=John S.|last3=Bradley|first3=T. Douglas|title=Sleep Apnea and Cardiovascular Disease|journal=Circulation|volume=126|issue=12|year=2012|pages=1495–1510|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.111.070813}}</ref>
* Screening for [[congenital]] [[complete heart block]] is recommended in [[pregnant]] [[women]] with Ro/SSA [[antibodies]].<ref name="pmid30137589">{{cite journal| author=Clowse MEB, Eudy AM, Kiernan E, Williams MR, Bermas B, Chakravarty E et al.| title=The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices. | journal=Rheumatology (Oxford) | year= 2018 | volume= 57 | issue= suppl_5 | pages= v9-v17 | pmid=30137589 | doi=10.1093/rheumatology/key141 | pmc=6099126 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30137589  }}</ref>
*[[Women]] with [[history]] of [[neonatal lupus]], [[fetal]] echos are recommended weekly or every other week from week 18 to 28.
* It is unclear how often [[first degree heart block]] progresses to [[complete heart block]], some cases my revert to [[normal sinus rhythm]] or [[complete heart block]].


*There is insufficient evidence to recommend routine screening for third degree AV block. However, screening for congenital AV block is recommended.
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
*Recommendations include echocardiogram for newborns of pregnant women with [[Autoantibodies|SSA autoantiboides]].
|-
*Timing for screening:<ref name="pmid30137589">{{cite journal| author=Clowse MEB, Eudy AM, Kiernan E, Williams MR, Bermas B, Chakravarty E et al.| title=The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices. | journal=Rheumatology (Oxford) | year= 2018 | volume= 57 | issue= suppl_5 | pages= v9-v17 | pmid=30137589 | doi=10.1093/rheumatology/key141 | pmc=6099126 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30137589  }}</ref>
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Recommendations for screening sleep apnea in patients with bradycardia or conduction disorder
**Women with history of [[neonatal lupus]], fetal echos are recommended weekly then repeating the echos every 3 or 4 weeks.
|-
**Women with prior infant with [[lupus]], echos are performed at the 16 weeks of gestation or 18 weeks.
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''  ([[ACC AHA guidelines classification scheme|Class I, Level of Evidence B]]):'''
*Fetal echos can be stopped by the 23 weeks of [[gestation]].
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑  Screening about [[sleep apnea syndrome]] is recommended In [[patients]] with documented or suspected [[bradycardia]] or [[conduction]] disorder during [[sleep]]<br>
❑ [[Continuous airway pressure]] and [[weight loss]] is recommended in [[patients]] with [[bradycardia]] or [[conduction]] disorder during [[sleep]] and documented [[obstructive sleep apnea]]<br>
|-
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''  ([[ACC AHA guidelines classification scheme|Class IIa, Level of Evidence B]]):'''
|-
|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ In [[patients]] with previously [[PPM]] implantation for [[bradycardia]] or [[conduction disorder]], screening about [[sleep apnea syndrome]] is reasonable<br> 
<br>
|}
{|
! colspan="2" style="background: PapayaWhip;" align="center" + |The above table adopted from 2018 AHA/ACC/HRS Guideline<ref name="KusumotoSchoenfeld2019">{{cite journal|last1=Kusumoto|first1=Fred M.|last2=Schoenfeld|first2=Mark H.|last3=Barrett|first3=Coletta|last4=Edgerton|first4=James R.|last5=Ellenbogen|first5=Kenneth A.|last6=Gold|first6=Michael R.|last7=Goldschlager|first7=Nora F.|last8=Hamilton|first8=Robert M.|last9=Joglar|first9=José A.|last10=Kim|first10=Robert J.|last11=Lee|first11=Richard|last12=Marine|first12=Joseph E.|last13=McLeod|first13=Christopher J.|last14=Oken|first14=Keith R.|last15=Patton|first15=Kristen K.|last16=Pellegrini|first16=Cara N.|last17=Selzman|first17=Kimberly A.|last18=Thompson|first18=Annemarie|last19=Varosy|first19=Paul D.|title=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|journal=Circulation|volume=140|issue=8|year=2019|issn=0009-7322|doi=10.1161/CIR.0000000000000628}}</ref>
|-
|}


==References==
==References==

Latest revision as of 07:58, 24 July 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Soroush Seifirad, M.D.[3] Aditya Ganti M.B.B.S. [4]

Overview

Ambulatory electrocardiographic monitoring is useful for finding intermittent atrioventricular block, LBBB and bifascicular block in asymptomatic patients. In patients with symptomatic atrioventricular block or bradycardia during sleep, screening about sleep apnea is recommended.

Screening


Recommendations for screening sleep apnea in patients with bradycardia or conduction disorder
(Class I, Level of Evidence B):

❑ Screening about sleep apnea syndrome is recommended In patients with documented or suspected bradycardia or conduction disorder during sleep
❑ Continuous airway pressure and weight loss is recommended in patients with bradycardia or conduction disorder during sleep and documented obstructive sleep apnea

(Class IIa, Level of Evidence B):

❑ In patients with previously PPM implantation for bradycardia or conduction disorder, screening about sleep apnea syndrome is reasonable

The above table adopted from 2018 AHA/ACC/HRS Guideline[3]

References

  1. ↑ Kasai, Takatoshi; Floras, John S.; Bradley, T. Douglas (2012). "Sleep Apnea and Cardiovascular Disease". Circulation. 126 (12): 1495–1510. doi:10.1161/CIRCULATIONAHA.111.070813. ISSN 0009-7322.
  2. ↑ Clowse MEB, Eudy AM, Kiernan E, Williams MR, Bermas B, Chakravarty E; et al. (2018). "The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices". Rheumatology (Oxford). 57 (suppl_5): v9–v17. doi:10.1093/rheumatology/key141. PMC 6099126. PMID 30137589.
  3. ↑ Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (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". Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.

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