Atrioventricular Dissociation Medication

Author: Chirag M Sandesara, MD; Chief Editor: Jeffrey N Rottman, MD more...

Updated: Apr 30, 2008

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Medication Summary
Anticholinergic agents
Adrenergic agonist agents
Antidotes
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References

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Class Summary

Competitive inhibitor at autonomic, postganglionic, and cholinergic receptors.

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Atropine IV/IM

Increases heart rate through vagolytic effects, causing increase in cardiac output.

Class Summary

Stimulate myocardial performance and improve coronary artery blood flow.

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Isoproterenol (Isuprel, Isopro)

Has beta1- and beta2-adrenergic receptor activity. Binds beta-receptors of heart, smooth muscle of bronchi, skeletal muscle, vasculature, and alimentary tract. Has positive inotropic and chronotropic actions.

Class Summary

Used to treat digitalis intoxication.

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Digoxin immune Fab (Digibind)

Immunoglobulin fragment with a specific and high affinity for both digoxin and digitoxin molecules. Removes digoxin or digitoxin molecules from tissue binding sites.

Each vial of Digibind contains 40 mg of purified digoxin-specific antibody fragments that bind approximately 0.6 mg of digoxin or digitoxin. The dose of antibody depends on total body load (TBL) of digoxin; estimates of TBL can be calculated in 3 ways, (1) estimate of the quantity of digoxin ingested in the acute ingestion and assume 80% bioavailability (mg ingested X 0.8 = TBL); (2) obtain a serum digoxin concentration and, using a pharmacokinetics formula, incorporate the volume of distribution (Vd) of digoxin and the patient's body weight in kg (TBL = digoxin serum level [ng/mL] X 6 L/kg X body weight in kg); and (3) use an empiric dose based on average requirements for an acute or chronic overdose in an adult or child.

If the quantity of ingestion cannot be estimated reliably, administer empirically (safest to use the largest calculated estimate); alternatively, be prepared to increase dosing if resolution is incomplete. Please see PDR for more complete information.

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Contributor Information and Disclosures

Author

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

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, 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

Ram C Sharma, MD, MRCP Assistant Professor of Medicine, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Louisville

Ram C Sharma, MD, MRCP is a member of the following medical societies: American Academy of Sleep Medicine, American College of Cardiology, and Royal College of Physicians of the United Kingdom

Disclosure: Nothing to disclose.

Roger Freedman, MD Director of Clinical Cardiology, 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

Specialty Editor Board

Alan D Forker, MD Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St 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

Francisco Talavera, PharmD, PhD Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Marschall S Runge, MD, PhD Charles and Anne Sanders Distinguished Professor of Medicine, Chairman, Department of Medicine, Vice Dean for Clinical Affairs, 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: Pfizer Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Orthoclinica Diagnostica Consulting fee Consulting

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

Jeffrey N Rottman, MD Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, 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.

References

Braunwald E. Atrioventricular dissociation. In: Braunwald E, Zipes DP, Libby P, eds. Heart Diseases: A Textbook Of Cardiovascular Medicine. 6^th ed. WB Saunders Co: Philadelphia, Pa; 2001.
Wagner GS. Atrioventricular dissociation. In: Wagner GSS, Marriott HJ, eds. Marriott's Practical Electrocardiography. 9th ed. Baltimore, Md: Williams & Wilkins; 1994.
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].
Duffield JS, Jacob AJ, Miller HC. Recurrent, life-threatening atrioventricular dissociation associated with toxoplasma myocarditis. Heart. Nov 1996;76(5):453-4. [Medline].
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].
Pick A. A-V dissociation. A proposal for a comprehensive classification and consistent terminology. Am Heart J. Aug 1963;66:147-50. [Medline].