Paroxysmal AV Block Etiology: Difference between revisions
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==Overview== | ==Overview== | ||
Intrinsic conduction/ structural defects particularly those located in this intra His Bundle (intrinsic AV block), low adenosine levels (idiopathic AV block) and increase vagal tone/vagal surge (extrinsic AV block) are the major causes of paroxysmal AV block. However, several reversible causes need to be ruled out before coming to a diagnosis. | [[Intrinsic]] [[conduction]]/ [[structural]] defects particularly those located in this [[intra]] [[His Bundle]] ([[Intrinsic paroxysmal AV block|intrinsic '''paroxysmal''' AV block]]), low [[adenosine]] levels ([[Idiopathic paroxysmal AV block|idiopathic '''paroxysmal''' AV block]]) and increase [[vagal]] tone/[[vagal]] surge ([[Extrinsic vagal paroxysmal av block|extrinsic vagal '''paroxysmal''' AV block]]) are the major causes of [[paroxysmal AV block]]. However, several reversible causes need to be ruled out before coming to a [[diagnosis]]. | ||
==Etiology== | ==Etiology== | ||
*'''Intrinsic conduction/ structural defects particularly those located in this intra His Bundle (intrinsic AV block), low adenosine levels (idiopathic AV block) and increase vagal tone/vagal surge (extrinsic AV block) are the major causes of paroxysmal AV block'''. | *'''[[Intrinsic conduction]]/ [[structural]] defects particularly those located in this intra [[His Bundle]] ([[intrinsic paroxysmal AV block]]), low adenosine levels ([[Intrinsic paroxysmal AV block|idiopathic paroxysmal AV block]]) and increase vagal tone/vagal surge ([[Extrinsic paroxysmal av block|extrinsic paroxysmal AV block]]) are the major causes of [[paroxysmal AV block]]'''. | ||
*However, some studies have shown an association of AV nodal blocking agents (beta blockers, calcium channel blockers), degenerative valvular heart disease, degeneration of the conduction system (the His bundle in particular), acute coronary syndromes (inferior /anterior wall myocardial infarction in particular) and paroxysmal AV block. | *However, some studies have shown an association of [[AV nodal block|AV nodal]] blocking agents ([[beta blockers]], [[calcium channel blockers]]), [[Degenerative disease|degenerative]] [[valvular heart disease]], [[Degeneration (medical)|degeneration]] of the [[Conduction system disease|conduction system]] (the [[Bundle of His|His bundle]] in particular), [[acute coronary syndromes]] ([[inferior]] [[Anterior|/anterior]] wall myocardial infarction in particular) and [[paroxysmal AV block]]. | ||
*Less common causes that have been cited are Lev- Lenegre disease, aneurysmal membranous septum, rheumatic heart disease, mitral valvulitis, sarcoidosis, h/o surgery and infective endocarditis with abscess formation. <ref name="pmid28496928">{{cite journal| author=Guerrero-Márquez FJ, Arana-Rueda E, Pedrote A| title=Idiopathic Paroxysmal Atrio-Ventricular Block. What is The Mechanism? | journal=J Atr Fibrillation | year= 2016 | volume= 9 | issue= 3 | pages= 1449 | pmid=28496928 | doi=10.4022/jafib.1449 | pmc=5368548 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496928 }} </ref> | *Less common causes that have been cited are [[Lev- Lenegre]] disease, [[Aneurysmal disease|aneurysmal]] membranous [[septum]], [[rheumatic heart disease]], [[Mitral valve|mitral]] valvulitis, [[sarcoidosis]], h/o [[surgery]] and [[infective endocarditis]] with [[abscess]] formation.<ref name="pmid28496928">{{cite journal| author=Guerrero-Márquez FJ, Arana-Rueda E, Pedrote A| title=Idiopathic Paroxysmal Atrio-Ventricular Block. What is The Mechanism? | journal=J Atr Fibrillation | year= 2016 | volume= 9 | issue= 3 | pages= 1449 | pmid=28496928 | doi=10.4022/jafib.1449 | pmc=5368548 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28496928 }} </ref> | ||
*A study of 20 patients conducted by '''Zabarski et al''' found that ischemic heart disease, dilated cardiomyopathy, carotid sinus hypersensitivity, chronic AV blocker consumption and aortic valve replacement were associated paroxysmal AV block.<ref name="pmid15561325">{{cite journal| author=Shohat-Zabarski R, Iakobishvili Z, Kusniec J, Mazur A, Strasberg B| title=Paroxysmal atrioventricular block: clinical experience with 20 patients. | journal=Int J Cardiol | year= 2004 | volume= 97 | issue= 3 | pages= 399-405 | pmid=15561325 | doi=10.1016/j.ijcard.2003.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561325 }} </ref> | *A study of 20 patients conducted by '''Zabarski et al''' found that [[ischemic heart disease]], [[dilated cardiomyopathy]], [[carotid sinus hypersensitivity]], chronic AV blocker consumption and [[aortic valve]] replacement were associated [[paroxysmal AV block]].<ref name="pmid15561325">{{cite journal| author=Shohat-Zabarski R, Iakobishvili Z, Kusniec J, Mazur A, Strasberg B| title=Paroxysmal atrioventricular block: clinical experience with 20 patients. | journal=Int J Cardiol | year= 2004 | volume= 97 | issue= 3 | pages= 399-405 | pmid=15561325 | doi=10.1016/j.ijcard.2003.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15561325 }} </ref> | ||
==2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Etiology of AV Block== | ==2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Etiology of AV Block== | ||
[[Image:Etiology of AV Block.JPG|thumb|center|500px| Etiology of AV Block<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on | [[Image:Etiology of AV Block.JPG|thumb|center|500px| Etiology of AV Block<ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710 }} </ref>]] | ||
==References== | ==References== | ||
Latest revision as of 09:06, 26 June 2020
Overview
Intrinsic conduction/ structural defects particularly those located in this intra His Bundle (intrinsic paroxysmal AV block), low adenosine levels (idiopathic paroxysmal AV block) and increase vagal tone/vagal surge (extrinsic vagal paroxysmal AV block) are the major causes of paroxysmal AV block. However, several reversible causes need to be ruled out before coming to a diagnosis.
Etiology
- Intrinsic conduction/ structural defects particularly those located in this intra His Bundle (intrinsic paroxysmal AV block), low adenosine levels (idiopathic paroxysmal AV block) and increase vagal tone/vagal surge (extrinsic paroxysmal AV block) are the major causes of paroxysmal AV block.
- However, some studies have shown an association of AV nodal blocking agents (beta blockers, calcium channel blockers), degenerative valvular heart disease, degeneration of the conduction system (the His bundle in particular), acute coronary syndromes (inferior /anterior wall myocardial infarction in particular) and paroxysmal AV block.
- Less common causes that have been cited are Lev- Lenegre disease, aneurysmal membranous septum, rheumatic heart disease, mitral valvulitis, sarcoidosis, h/o surgery and infective endocarditis with abscess formation.[1]
- A study of 20 patients conducted by Zabarski et al found that ischemic heart disease, dilated cardiomyopathy, carotid sinus hypersensitivity, chronic AV blocker consumption and aortic valve replacement were associated paroxysmal AV block.[2]
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Etiology of AV Block
References
- ↑ Guerrero-Márquez FJ, Arana-Rueda E, Pedrote A (2016). "Idiopathic Paroxysmal Atrio-Ventricular Block. What is The Mechanism?". J Atr Fibrillation. 9 (3): 1449. doi:10.4022/jafib.1449. PMC 5368548. PMID 28496928.
- ↑ Shohat-Zabarski R, Iakobishvili Z, Kusniec J, Mazur A, Strasberg B (2004). "Paroxysmal atrioventricular block: clinical experience with 20 patients". Int J Cardiol. 97 (3): 399–405. doi:10.1016/j.ijcard.2003.10.023. PMID 15561325.
- ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: 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): 932–987. doi:10.1016/j.jacc.2018.10.043. PMID 30412710.