Third degree AV block surgery
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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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Surgery
Implantation of permanent pacemakers in both asymptomatic and symptomatic patients is usually done. Asymptomatic Mobitz II are prone to be converted to symptomatic or third degree heart AV block. Thus, they should be considered for a pacemaker even if asymptomatic.
Pacemaker Indications
Permanent pacemaker implantation indications in complete heart block include:
- Symptomatic bradycardia (including heart failure)
- Ventricular arrhythmias presumed to be due to AV block
- Awake, symptom-free patients in sinus rhythm with documented periods of asystole 3 seconds or longer
- Any escape rate less than 40 beats/min
- Escape rhythm that is below the AVN
- Asymptomatic patients with atrial fibrillation and bradycardia with 1 or more pauses of at least 5 seconds or longer
- After catheter ablation of the AV junction
- Postoperative complete heart block
- Average resting heart rate of over 40 beats per minute while awake in an asymptomatic patient
- Certain neuromuscular diseases which have a high potential for unpredictable rapid progression of conduction blocks
Pacing Mode
VVI pacing mode was widely used in the past. But this mode has been shown to be associated with AV dyssynchrony leading to pacemaker syndrome. A dual chamber DDD pacemaker is preferred over a single chambered VVI pacemakers as it maintains physiologic AV synchrony. A dual-chamber artificial pacemaker is a type of device that typically listens for a pulse from the SA node and sends a pulse to the AV node at an appropriate interval, essentially completing the connection between the two nodes. Pacemakers in this role are usually programmed to enforce a minimum heart rate and to record instances of atrial flutter and atrial fibrillation , two common secondary conditions that can accompany third degree AV block.