Third 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: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
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Medical Therapy
Correction of reversible causes of the block such as ischemia, medications (beta-blockers, calcium channel blockers, antiarrhythmics, and digoxin), and vagotonic conditions should be considered. Treatment may also include medicines to control blood pressure and atrial fibrillation, as well as lifestyle and dietary changes to reduce risk factors associated with heart attack and stroke. A new third degree AV block is an emergency. Treatment in emergency situations are atropine and an external pacer.
A patient with inferior wall myocardial infarction and distal high grade complete heart block with a heart rate of more than 60 beats per minute is at immediate danger of asystole and requires an immediate placement of permanent pacemaker compared to a patient with inferior myocardial infarction and complete block at the level of AV node with a heart rate of 35-40 beats per minute.
Atropine can partially or completely restore conduction through the AV node when the cause for complete heart block is acute myocardial infarction (ischemia of the AV node). Atropine, in this setting, reverses the reduced conduction across the AV node (which is due to increased vagal tone).