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Atrioventricular Dissociation Treatment & Management

  • Author: Chirag M Sandesara, MD; Chief Editor: Jeffrey N Rottman, MD  more...
 
Updated: Dec 18, 2014
 

Medical Care

Treatment depends on the underlying condition and its severity. The important considerations and steps in the treatment of patients with AV dissociation include the hemodynamic status of the patient and recognition of the underlying pathology.

For patients who are hemodynamically unstable, ie, patients with ventricular tachycardia, the initial treatment of choice is direct-current cardioversion or intravenous drug therapy, depending on the stability of the patient. Treatment of digoxin toxicity should also be pursued.

Ascertaining if AV conduction is intact is important in patients with AV dissociation due to an accelerated junctional rhythm following cardiac surgery. Rarely, patients have complete AV block with an accelerated focus distal to the level of block; when the accelerated focus becomes quiescent, heart block is present.

Monitor patients closely for medications that can cause AV dissociation.

Correct electrolyte imbalances.

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Surgical Care

A permanent pacemaker is rarely necessary.

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Consultations

Patients with unexplained or uncorrected persistent symptomatic AV dissociation due to an escape rhythm or ventricular tachycardia may require referral to an electrophysiologist or a cardiologist.

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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, Heart Rhythm Society

Disclosure: Nothing to disclose.

Coauthor(s)

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

Brian Olshansky, MD is a member of the following medical societies: American College of Cardiology, Heart Rhythm Society, Cardiac Electrophysiology Society, American Heart Association

Disclosure: Received honoraria from Guidant/Boston Scientific for speaking and teaching; Received honoraria from Medtronic for speaking and teaching; Received consulting fee from Guidant/Boston Scientific for consulting; Received consulting fee from BioControl for consulting; Received consulting fee from Boehringer Ingelheim for consulting; Received consulting fee from Amarin for review panel membership; Received consulting fee from sanofi aventis for review panel membership.

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, Heart Rhythm Society, American College of Physicians, American Heart Association, Phi Beta Kappa, Sigma Xi

Disclosure: Received grant/research funds from St. Jude Medical for other; Received consulting fee from St. Jude Medical for consulting; Received ownership interest from St. Jude Medical for other; Received grant/research funds from Boston Scientific for other; Received consulting fee from Boston Scientific for consulting; Received grant/research funds from Medtronic for other; Received consulting fee from Medtronic for consulting; Received consulting fee from Sorin for 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: Received salary from Medscape for employment. for: Medscape.

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 Physiological Society, American Society for Clinical Investigation, American Society for Investigative Pathology, Association of American Physicians, Texas Medical Association, Southern Society for Clinical Investigation, American Federation for Clinical Research, Association of Professors of Medicine, Association of Professors of Cardiology, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, American Federation for Medical Research, American Heart Association

Disclosure: Received honoraria from Pfizer for speaking and teaching; Received honoraria from Merck for speaking and teaching; Received consulting fee from Orthoclinica Diagnostica for consulting.

Chief Editor

Jeffrey N Rottman, MD Professor of Medicine, Department of Medicine, Division of Cardiovascular Medicine, University of Maryland School of Medicine; Cardiologist/Electrophysiologist, University of Maryland Medical System and VA Maryland Health Care System

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association, Heart Rhythm Society

Disclosure: Nothing to disclose.

Acknowledgements

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.

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

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

  3. 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. 1996 Dec. 76(6):541-7. [Medline].

  4. Ho RT, Pietrasik G, Greenspon AJ. A narrow complex tachycardia with intermittent atrioventricular dissociation: What is the mechanism?. Heart Rhythm. 2014 Nov. 11(11):2116-9. [Medline].

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

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

  7. Ogunlade O, Akintomide AO, Ajayi OE, Eluwole OA. Marked first degree atrioventricular block: an extremely prolonged PR interval associated with atrioventricular dissociation in a young Nigerian man with pseudo-pacemaker syndrome: a case report. BMC Res Notes. 2014 Nov 4. 7:781. [Medline]. [Full Text].

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

 
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Atrioventricular (AV) dissociation. Ventricular tachycardia and complete AV dissociation. P waves are marked.
Atrioventricular (AV) dissociation. Complete AV block and no fixed relationship between P waves and QRS complexes.
Diagnostic algorithm for atrioventricular dissociation.
 
 
 
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