Second degree AV block medical therapy
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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, 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 atropine.
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 |
Mobitz I
- Patients with type I second degree AV block are usually asymptomatic and do not require treatment.[1][2].
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be addressed[3].
- 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.[1]
Mobitz II
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be considered[4].
- Patients may need immediate transvenous pacing until a permanent pacemaker is placed[1].
- Treatment in emergency situations are atropine and an external pacer.[5][6].
References
- ↑ 1.0 1.1 1.2 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.