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 (Wenckebach) is often not necessary. Occasionally type I blocks may result in bradycardia leading to hypotension. If hypotension and bradycardia occur, type I blocks respond 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 dose of these medications should be reduced or the medication 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. Type II blocks imply structural damage to the AV conduction system. This rhythm often deteriorates into complete heart block. These patients require transvenous pacing until a permanent pacemaker is placed. Unlike Mobitz type I (Wenckebach), patients that are bradycardic and hypotensive with a Mobitz type II rhythm often do not respond to atropine.
Medical Therapy
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 is used in Type I blocks with hypotension and bradycardia. Transvenous or transcutaneous Pacing may be needed to stabilize the patient only if 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 need immediate transvenous pacing until a permanent pacemaker is placed[1].
- 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[5].
- Treatment in emergency situations are atropine and an external pacer[6][7].
Contraindicated medications
Second degree AV block(except in patients with a functioning artificial pacemaker)[8][9] is considered an absolute contraindication to the use of the following medications:
- Adenosine
- Atenolol
- Betaxolol
- Bisoprolol
- Brimonidine tartrate and Timolol maleate
- Carteolol
- Diltiazem
- Disopyramide
- Dronedarone
- Flecainide
- Metoprolol
- Mexiletine
- Nadolol
- Nebivolol
- Penbutolol
- Pindolol
- Propranolol
- Sotalol
- Timolol
- Labetalol[10]
References
- ↑ 1.0 1.1 1.2 Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(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
|title=(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.
- ↑ Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, Strohmer B (March 2016). "Short-term pacemaker dependency after transcatheter aortic valve implantation". Wien. Klin. Wochenschr. 128 (5–6): 198–203. doi:10.1007/s00508-015-0906-4. PMID 26745972.
- ↑ 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.
- ↑ Brignole M, Deharo JC, Guieu R (August 2015). "Syncope and Idiopathic (Paroxysmal) AV Block". Cardiol Clin. 33 (3): 441–7. doi:10.1016/j.ccl.2015.04.012. PMID 26115830.
- ↑ Kelkar PN (August 1998). "Atenolol induced high grade AV block". J Assoc Physicians India. 46 (8): 748, 751. PMID 11229299.
- ↑ Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M, Viskin S (July 2004). "Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug". J. Am. Coll. Cardiol. 44 (1): 105–8. doi:10.1016/j.jacc.2004.03.057. PMID 15234417.