Second degree AV block medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Treatment for a Mobitz type I second-degree [[AV block]] (Wenckebach) is often not necessary. Occasionally Mobitz type 1 second degree [[AV blocks]] may result in [[bradycardia]] leading to [[hypotension]] and responds well to [[atropine]]. If unresponsive to [[atropine]] or [[beta-adrenergic agonist]]s, pacing (transcutaneous or transvenous) should be initiated for stabilization. If the [[patient]] is on any [[beta-blockers]], [[calcium channel blockers]] or [[digoxin]], the [[medication]]s should be discontinued. All [[patients]] with Mobitz 1 block should be admitted and monitored. Treatment for a Mobitz type II involves initiating pacing as soon as this [[rhythm]] is identified. Mobitz type II second-degree [[AV blocks]] may imply structural damage to the [[AV conduction system]]. This [[rhythm]] often deteriorates into a [[complete heart block]]. These [[patients]] require transvenous pacing until a [[permanent pacemaker]] is placed. Unlike Mobitz type I second degree [[AV block]] ([[Wenckebach]]), Mobitz type II rhythm often do not respond to [[atropine]]. | Treatment for a Mobitz type I second-degree [[AV block]] (Wenckebach) is often not necessary. Occasionally Mobitz type 1 second degree [[AV blocks]] may result in [[bradycardia]] leading to [[hypotension]] and responds well to [[atropine]]. If unresponsive to [[atropine]] or [[beta-adrenergic agonist]]s, pacing (transcutaneous or transvenous) should be initiated for stabilization. If the [[patient]] is on any [[beta-blockers]], [[calcium channel blockers]] or [[digoxin]], the [[medication]]s should be discontinued. All [[patients]] with Mobitz 1 block should be admitted and monitored. Treatment for a Mobitz type II involves initiating pacing as soon as this [[rhythm]] is identified. Mobitz type II second-degree [[AV blocks]] may imply structural damage to the [[AV conduction system]]. This [[rhythm]] often deteriorates into a [[complete heart block]]. These [[patients]] require transvenous pacing until a [[permanent pacemaker]] is placed. Unlike Mobitz type I second degree [[AV block]] ([[Wenckebach]]), Mobitz type II rhythm often do not respond to [[atropine]]or [[beta-adrenergic agonist]]s. | ||
==Medical Therapy== | ==Medical Therapy== |
Revision as of 10:46, 11 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, M.D. Cafer Zorkun, M.D., Ph.D. [2] Syed Musadiq Ali M.B.B.S.[3]
Overview
Treatment for a Mobitz type I second-degree AV block (Wenckebach) is often not necessary. Occasionally Mobitz type 1 second degree AV blocks may result in bradycardia leading to hypotension and responds well to atropine. If unresponsive to atropine or beta-adrenergic agonists, pacing (transcutaneous or transvenous) should be initiated for stabilization. If the patient is on any beta-blockers, calcium channel blockers or digoxin, the medications should be discontinued. All patients with Mobitz 1 block should be admitted and monitored. Treatment for a Mobitz type II involves initiating pacing as soon as this rhythm is identified. Mobitz type II second-degree AV blocks may imply structural damage to the AV conduction system. This rhythm often deteriorates into a complete heart block. These patients require transvenous pacing until a permanent pacemaker is placed. Unlike Mobitz type I second degree AV block (Wenckebach), Mobitz type II rhythm often do not respond to atropineor beta-adrenergic agonists.
Medical Therapy
Recommendations for acute medical therapy for bradycardia associated atrioventricular block |
Medical therapy (Class IIa, Level of Evidence C): |
❑ Atropine is reasonable for patients with symptomatic bradycardia associated second-degree or third degree atrioventricular block at the atrioventricular nodal level |
Medical therapy (Class IIb, Level of Evidence B): |
❑ Beta adrenergic agonist such as isoproterenol, dopamine, dobutamine is recommended for symptomatic bradycardia associated second degree or third degree atrioventricular block with low likehood of ischemia |
Medical therapy (Class IIb, Level of Evidence C): |
❑ Aminophylline is recommended for symptomatic bradycardia associated second or third degree atrioventricular block in the setting of acute inferior MI |
The above table adopted from 2018 AHA/ACC/HRS Guideline[1] |
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Mobitz I
- Patients with type I second degree AV block are usually asymptomatic and do not require treatment.[2][3].
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be addressed[4].
- Atropine can be used in Type I second degree AV blocks with hypotension and bradycardia.
- Transvenous or transcutaneous Pacing may be needed to stabilize the patient when bradycardia is unresponsive to atropine.[2]
Mobitz II
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be considered[5].
- Patients may need immediate transvenous pacing until a permanent pacemaker is placed[2].
- Treatment in emergency situations are atropine and an external pacer.[6][7].
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
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(help) - ↑ Hisamura M, Taguchi H, Hiraide A (January 2016). "Mobitz type 1 second-degree atrioventricular block by triazolam and brotizolam overdose". Acute Med Surg. 3 (1): 57–58. doi:10.1002/ams2.121. PMC 5667231. PMID 29123752.
- ↑ Kashou AH, Goyal A, Nguyen T, Chhabra L. PMID 29083636. Missing or empty
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(help) - ↑ Li X, Xue Y, Wu H (2018). "A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration". Case Rep Vasc Med. 2018: 9385017. doi:10.1155/2018/9385017. PMC 5933017. PMID 29850368.
- ↑ 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.
- ↑ 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.