eMedicine Specialties > Cardiology > Arrhythmias

Atrioventricular Dissociation: Differential Diagnoses & Workup

Author: Chirag M Sandesara, MD, Fellow, Department of Internal Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics
Coauthor(s): Brian Olshansky, MD, Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine; Ram C Sharma, MD, MRCP, Assistant Professor of Medicine, Division of Cardiology, Department of Internal Medicine, University of Utah Health Science Center; Roger Freedman, MD, Director of Arrhythmia Service, Director of Electrophysiology Fellowship, Professor, Department of Internal Medicine, Division of Cardiology, University of Utah School of Medicine
Contributor Information and Disclosures

Updated: Aug 9, 2006

Differential Diagnoses

Atrioventricular Block

Workup

Laboratory Studies

  • Digoxin level

Other Tests

  • The electrocardiogram is the most commonly used modality to diagnose this problem. Findings show the underlying rhythm and P-wave morphology. In complete AV dissociation, P waves and QRS complexes have no fixed temporal relationship to each other. P-wave morphology depends on atrial activation.
  • The relationship between the atrial and ventricular rates is very important to understanding AV dissociation (see Images 1-2). The ventricular rate is the same or faster than the atrial rate.
  • Occasionally, other methods are required to assess atrial and ventricular activation, and the diagnostic approach to AV dissociation is given in Image 3.
  • Determining whether a P wave conducts can be difficult. To distinguish AV conduction from AV block, having the patient perform a maneuver to change the atrial and ventricular rate may help. While attached to a monitor, the patient can sit up or can perform some form of exercise.

More on Atrioventricular Dissociation

Overview: Atrioventricular Dissociation
Differential Diagnoses & Workup: Atrioventricular Dissociation
Treatment & Medication: Atrioventricular Dissociation
Follow-up: Atrioventricular Dissociation
Multimedia: Atrioventricular Dissociation
References
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References

  1. Braunwald E. Atrioventricular dissociation. In: Braunwald E, Zipes DP, Libby P, eds. Heart Diseases: A Textbook Of Cardiovascular Medicine. 6th ed. Philadelphia, Pa: WB Saunders Co;. 2001.

  2. Duffield JS, Jacob AJ, Miller HC. Recurrent, life-threatening atrioventricular dissociation associated with toxoplasma myocarditis. Heart. Nov 1996;76(5):453-4. [Medline].

  3. Luzza F, Oreto G. Pseudo-atrioventricular dissociation caused by interpolated ventricular extrasystoles in the presence of dual atrioventricular nodal pathway. Chest. May 1994;105(5):1587-9. [Medline].

  4. Oreto G, Smeets JL, Rodriguez LM, et al. Wide complex tachycardia with atrioventricular dissociation and QRS morphology identical to that of sinus rhythm: a manifestation of bundle branch reentry. Heart. Dec 1996;76(6):541-7. [Medline].

  5. Pick A. A-V dissociation. A proposal for a comprehensive classification and consistent terminology. Am Heart J. Aug 1963;66:147-50. [Medline].

  6. Wagner GS. Atrioventricular dissociation. In: Wagner GSS, Marriott HJ, eds. Marriott's Practical Electrocardiography. 9th ed. Baltimore, Md: Williams & Wilkins;. 1994.

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Further Reading

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Keywords

atrioventricular dissociation, AV dissociation, A-V dissociation, AV block, A-V block, heart block, complete heart block, bradycardia, tachycardia, AV dyssynchrony, ventricular tachycardia, nonparoxysmal junctional tachycardia, junctional tachycardia, escape junctional rhythm, accelerated idioventricular rhythm

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Contributor Information and Disclosures

Author

Chirag M Sandesara, MD, Fellow, Department of Internal Medicine, Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics
Chirag M Sandesara, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Heart Association, and American Medical Association
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; Reliant Grant/research funds Other; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

Ram C Sharma, MD, MRCP, Assistant Professor of Medicine, Division of Cardiology, Department of Internal Medicine, University of Utah Health Science Center
Ram C Sharma, MD, MRCP is a member of the following medical societies: American College of Physicians and American Heart Association
Disclosure: Nothing to disclose.

Roger Freedman, MD, Director of Arrhythmia Service, Director of Electrophysiology Fellowship, Professor, Department of Internal Medicine, Division of Cardiology, University of Utah School of Medicine
Roger Freedman, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, Heart Rhythm Society, Phi Beta Kappa, and Sigma Xi
Disclosure: St. Jude Medical Grant/research funds Other; St. Jude Medical Consulting fee Consulting; St. Jude Medical Ownership interest Other; Boston Scientific Grant/research funds Other; Boston Scientific Consulting fee Consulting; Medtronic Grant/research funds Other; Medtronic  Consulting; Sorin Consulting fee Consulting

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, MidAmerica Heart Institute, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of Saint Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Marschall S Runge, MD, PhD, Marion Covington Distinguished Professor of Medicine, Vice Dean for Clinical Affairs, Chairman, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine
Marschall S Runge, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Southern Society for Clinical Investigation, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Leonard Ganz, MD, Associate Professor of Medicine, Temple University School of Medicine; Cardiac Electrophysiologist, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Cent, West Penn Hospital
Disclosure: Nothing to disclose.

 
 
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