Third degree AV block other imaging findings

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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

Determination the underlying cardiac or non-cardiac cause of bradycardia or conduction disorder has prognostic value. When the structural heart disease can not be identified by echocardiography, advanced imaging including TEE, cardiac computed tomography, cardiac MRI may be helpful in selected patients.

Other Imaging Findings

Recommendation for cardiac imaging for management of bradycardia associated atrioventricular block

Transthoracic echocardiography (Class I , Level of Evidence B):

❑Transthoracic echocardiography is recommended in patients with newly identified LBBB, Second-degree mobitz type2 AV block, high grade AV block, third-degree AV block with or without diagnosed structural heart disease or coronary artery disease

Transthoracic echocardiography (Class IIa , Level of Evidence B):

❑ Transthoracic echocardiography is reasonable in patients with bradycardia or conduction disorder other than LBBB, Second-degree mobitz type2 AV block, high grade AV block, third-degree AV block in suspicion of structural heart disease

Advanced imaging (Class IIa , Level of Evidence C):

❑ Transesophageal echocardiography, computed tomography, cardiac magnetic resonance is recommended for patients with bradycardia or bundle branch block in suspicion of structural heart disease undiagnosed by other modalities

Pharmacologic challenge tests (Class IIb , Level of Evidence C):

❑Atropine, procainamide, isoproternole, carotide sinus massage may be used in selected patients with second degree AV block to determine the level of block and benefit from permanent pacing

The above table adopted from 2018 AHA/ACC/HRS Guideline