Third degree AV block natural history, complications and prognosis
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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] Raviteja Guddeti, M.B.B.S. [3]
Overview
Spontaneous recovery from third degree heart block is very rare. If left untreated third degree heart block is associated with a high mortality which appears to occur as a consequence of the complications of prematurity and bradycardia owing to the delayed initiation of pacing therapy. Patients with third-degree heart blocks are vulnerable to decreased perfusion related to symptomatic bradycardia and decreased cardiac output. Common complications of third degree AV block include sudden cardiac death due to asystole, syncope and musculoskeletal injuries secondary to fall after syncope.
Natural History, Complications, and Prognosis
Natural History
- Spontaneous recovery from third degree heart block is very rare.
- The estimated overall mortality of non-paced patients with isolated AV block is 8%–16% in infants and 4%–8% in children and adults.
- If left untreated third degree heart block is associated with a high mortality which appears to occur as a consequence of the complications of prematurity and bradycardia owing to the delayed initiation of pacing therapy.
Complications
- Patients with third-degree heart blocks are vulnerable to decreased perfusion related to symptomatic bradycardia and decreased cardiac output.
- Critically ill patients may be unable to protect their airway and may develop nausea, possibly aspirate, and may have delirium.
- Treatment-related complications in the short term are malposition or dislodgement of a pacemaker lead and cardiac perforation in the short term and pacemaker associated heart failure in the long term.
- Common complications of third degree AV block include:
- Sudden cardiac death due to asystole
- Syncope
- Musculoskeletal injuries secondary to fall after syncope.
- Cardiovascular collapse
- Hypotension
- Stokes-Adams syndrome
- Ventricular tachycardia
- Ventricular fibrillation
- Worsening of heart failure
- Worsening of angina
- Death
Prognosis
- The prognosis of third degree heart block is most likely dependent on the patient's underlying disease burden and severity of the clinical presentation on arrival.
- Complete heart block is sometimes reversible in settings such as acute MI by restoring coronary perfusion and in conditions such as Lymes disease by treatment with antibiotics.
- Patients treated with permanent pacemaker have an excellent prognosis.
- Patients with complete heart block due to acute myocardial infarction are at a greater risk for sudden cardiac death.