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==Other Imaging Findings==
==Other Imaging Findings==
Nuclear imaging techniques might rarely be used and may be helpful in the diagnosis of complications of [[third degree AV block ]] or provide shreds of evidence in favor of the underlying disease in those with [[complete heart block]]. Imaging modalities might include:
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
 
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*Accurate [[ejection fraction] measurement by means of [[nuclear]] medicine
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF;" align=center |'''Additional testing for management of bradycardia associated atrioventricular block'''
*[[PET scan]] to diagnose hidden [[infection]] or [[malignancy]]
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*Finally, if there are concerns for [[ischemic heart disease]], nuclear medicine stress testing might be helpful and may show pieces of evidence of [[coronary]] [[ischemia]] during [[exercise]]/chemical [[stress test]].
|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[ Ambulatory electrocardiographic monitoring]] ([[ACC AHA guidelines classification scheme|Class IIa , Level of Evidence B]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[Ambulatory electrocardiographic monitoring]] is recommended in [[patients]] with [[first degree AV block]], or mobitz type 1 [[second degree AV block]] to establish the correlation between [[symptoms]] related to bradycardia ([[lightheadness]], [[syncope]]) and [[atrioventricular block]]<br>
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|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |''' [[Exercise treadmill test]] ([[ACC AHA guidelines classification scheme|Class IIa , Level of Evidence C]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑ [[Exercise treadmill test]] is reasonable in [[patients]] with [[first degree AV block]] or mobitz type 1 [[second degree AV block]] in resting [[ECG]] who have [[chest pain]] or [[shortness of breath]] during [[exercise]] to identify the benefit of [[permanent pacing]]<br>
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|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Electrophysiologic study]] ([[ACC AHA guidelines classification scheme|Class IIb , Level of Evidence B]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑[[EPS]] may be considered in selective [[patients]] with [[second degree AV block]] to determine the level of block<br>
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|style="font-size: 100; padding: 0 5px; background: #B8B8B8" align=left |'''[[Pharmacologic challenge tests]] ([[ACC AHA guidelines classification scheme|Class IIb , Level of Evidence C]]):'''
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|style="padding: 0 5px; font-size: 100%; background: #F5F5F5; width: 70%" align=left|
❑[[Atropine]], [[procainamide]], [[isoproternole]], [[carotide sinus massage]] may be used in selected [[patients]] with [[second degree AV  block]] to determine the level of block and benefit from [[permanent pacing]]<br>
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! 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>
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|}


==References==
==References==

Revision as of 11:07, 25 July 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]

Overview

Nuclear imaging techniques might rarely used and may be helpful in the diagnosis of complications of third degree AV block or provide shreds of evidence in favor of the underlying disease in those with compete heart block.

Other Imaging Findings


Additional testing for management of bradycardia associated atrioventricular block
Ambulatory electrocardiographic monitoring (Class IIa , Level of Evidence B):

❑ Ambulatory electrocardiographic monitoring is recommended in patients with first degree AV block, or mobitz type 1 second degree AV block to establish the correlation between symptoms related to bradycardia (lightheadness, syncope) and atrioventricular block

Exercise treadmill test (Class IIa , Level of Evidence C):

❑ Exercise treadmill test is reasonable in patients with first degree AV block or mobitz type 1 second degree AV block in resting ECG who have chest pain or shortness of breath during exercise to identify the benefit of permanent pacing

Electrophysiologic study (Class IIb , Level of Evidence B):

❑EPS may be considered in selective patients with second degree AV block to determine the level of block

Pharmacologic challenge tests (Class IIb , Level of Evidence C):

❑Atropine, procainamide, isoproternole, carotide sinus massage may be used in selected patients with second degree AV block to determine the level of block and benefit from permanent pacing


The above table adopted from 2018 AHA/ACC/HRS Guideline[1]

References

  1. ↑ 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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