Atrioventricular Dissociation Treatment & Management
- Author: Chirag M Sandesara, MD; Chief Editor: Jeffrey N Rottman, MD more...
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.
Surgical Care
A permanent pacemaker is rarely necessary.
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.
Braunwald E. Atrioventricular dissociation. In: Braunwald E, Zipes DP, Libby P, eds. Heart Diseases: A Textbook Of Cardiovascular Medicine. 6th 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].

