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]

Overview

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.

Echocardiography

• Echocardiography is useful for evaluation of underlying structural heart disease in patients presented with bradycardia or conduction abnormality including cardiomyopathy, valvular heart disease, congenital anomalies, tumors, infections, infiltrative processes, immunologically mediated conditions, and diseases of the great vessels and pericardium.
• 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