Atrioventricular Block Medication

  • Author: Chirag M Sandesara, MD, FACC; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Oct 13, 2011
 

Medication Summary

Long-term medical therapy is not indicated in atrioventricular (AV) block. Permanent pacing is the therapy of choice in advanced AV block, and it does not require concomitant medical therapy. Sometimes AV nodal blocking medications that contribute to heart block can be discontinued if not necessary. Atropine administration (0.5-1.0 mg) or isoproterenol infusion may improve AV conduction in emergencies where bradycardia is caused by a proximal AV block (located in the atrioventricular node [AVN]) but may worsen conduction if the block is in the His-Purkinje system.

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Anticholinergic Agents

Class Summary

The goal of administering anticholinergic agents is to improve conduction through the AVN by reducing vagal tone via muscarinic receptor blockade. This is only effective if the site of block is within the AVN. For patients with suspected infranodal block, this therapy is ineffective and may make the level of the block worse if it is in the His bundle or below.

Atropine IV/IM (Atropair, Atropisol)

 

Atropine increases AV conduction. An insufficient dose may cause paradoxical slowing of the heart rate.

Isoproterenol (Isuprel)

 

Isoproterenol has beta1- and beta2-adrenergic receptor activity. It binds the beta-receptors of the heart, smooth muscle of bronchi, skeletal muscle, the vasculature, and the alimentary tract. It has positive inotropic and chronotropic actions.

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Contributor Information and Disclosures
Author

Chirag M Sandesara, MD, FACC  Virginia Cardiovascular Associates, Cardiac Rhythm Care

Chirag M Sandesara, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

Brian Olshansky, MD  Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences

Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steven J Compton, MD, FACC, FACP  Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Wojciech Zareba, MD, PhD, FACC, and Stacy D Fisher, MD, to the development and writing of the source article.

References
  1. Schott JJ, Alshinawi C, Kyndt F, et al. Cardiac conduction defects associate with mutations in SCN5A. Nat Genet. Sep 1999;23(1):20-1. [Medline].

  2. Cheng S, Keyes MJ, Larson MG, et al. Long-term outcomes in individuals with prolonged PR interval or first-degree atrioventricular block. JAMA. Jun 24 2009;301(24):2571-7. [Medline]. [Full Text].

  3. Crisel RK, Farzaneh-Far R, Na B, Whooley MA. First-degree atrioventricular block is associated with heart failure and death in persons with stable coronary artery disease: data from the Heart and Soul Study. Eur Heart J. Aug 2011;32(15):1875-80. [Medline].

  4. Epstein AE, Dimarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. Heart Rhythm. Jun 2008;5(6):934-55. [Medline].

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First-degree atrioventricular block. PR interval is constant and is 280 msec.
Second-degree atrioventricular block, Mobitz type I (Wenckebach). Note the prolongation of the PR interval preceding the dropped beat and the shortened PR interval following the dropped beat.
Second-degree atrioventricular block, Mobitz type II. A constant PR interval in conducted beats is present. Intraventricular conduction delay also is present.
Third-degree atrioventricular block (complete heart block). The atrial rate is faster than the ventricular rate, and no association exists between the atrial and ventricular activity.
 
 
 
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