Third degree AV block echocardiography and ultrasound

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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]

Echocardiography

• Echocardiography is useful for evaluation of underlying structural heart disease in patients presented with bradycardia or conduction abnormality.
• Common indications for echocardiography in suspicion of cardiac origin of bradycardia or conduction disorder may include:
• Syncope
• Lightheadedness/presyncope
• Symptoms related to aortic stenosis, hypertrophic cardiomyopathy, heart failure

Recommendations for Echocardiography in Bradycardia or Conduction disorder

Medical therapy (Class I, Level of Evidence B):

❑ Echocardiography is recommended in patients with newly identified LBBB, second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block with or without apparent structural heart disease or coronary artery disease

Echocardiography ( Class IIa, Level of Evidence B) :

❑ Echocardiography is recommended in suspicion of structural heart disease in patients presented with bradycardia or conduction disorders other than LBBB, second-degreeMobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block

Advanced imaging : (Class IIa, Level of Evidence C)

❑ In suspicion of structural heart disease in patients presented with bradycardia or bundle branch block, transesophageal echocardiography, computed tomography, cardiac magnetic resonance imaging (MRI),or nuclear imaging is recommended

Cardiac imaging : (Class III, Level of Evidence B)

❑ Routine cardiac imaging is not recommended in patients with asymptomatic sinus bradycardia or first-degree atrioventricular block and no clinical evidence of structural heart disease

Abbreviations: PPM: Permanent pacemaker; LBBB: Left bundle branch block

The above table adopted from 2018 AHA/ACC/HRS Guideline