First-Degree Atrioventricular Block Medication

  • Author: Jamshid Alaeddini, MD, FACC; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Jun 29, 2011
 

Medication Summary

Use of medication is not indicated for treatment of asymptomatic first-degree atrioventricular (AV) block. However, in patients with severe bradycardia or those with the possibility of progression to higher-degree AV block, medications (eg, atropine, isoproterenol) can be used in anticipation of insertion of a cardiac pacemaker.

Next

Anticholinergic Agents

Class Summary

Parasympathetic blockade shortens the PR interval by improving AV nodal conduction.

View full drug information

Atropine IV/IM (AtroPen)

 

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

Previous
Next

Sympathomimetics

Class Summary

Isoproterenol infusion can be used to shorten AV conduction time. Isoproterenol has chronotropic as well as inotropic effects, which result in an increase in cardiac output.

View full drug information

Isoproterenol (Isuprel)

 

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

Previous
 
Contributor Information and Disclosures
Author

Jamshid Alaeddini, MD, FACC  Clinical Cardiac Electrophysiologist, Inland Cardiology Associates

Jamshid Alaeddini, MD, FACC is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; St. Jude Honoraria Speaking and teaching; Reliant Honoraria Speaking and teaching

Coauthor(s)

Theodore J Gaeta, DO, MPH, FACEP  Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Michael D Levine, MD  Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center; Physician, Department of Emergency Medicine, Banner Thunderbird Medical Center

Michael D Levine, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jamshid Shirani, MD  Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, St Luke's Hospital and Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Echocardiography, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Specialty Editor Board

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

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

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

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.

References

  1. John AD, Fleisher LA. Electrocardiography: the ECG. Anesthesiol Clin. Dec 2006;24(4):697-715, v-vi. [Medline].

  2. Barold SS, Ilercil A, Leonelli F, Herweg B. First-degree atrioventricular block. Clinical manifestations, indications for pacing, pacemaker management & consequences during cardiac resynchronization. J Interv Card Electrophysiol. Nov 2006;17(2):139-52. [Medline].

  3. Sherron P, Torres-Arraut E, Tamer D, Garcia OL, Wolff GS. Site of conduction delay and electrophysiologic significance of first-degree atrioventricular block in children with heart disease. Am J Cardiol. May 1 1985;55(11):1323-7. [Medline].

  4. Berger PB, Ruocco NA, Ryan TJ, et al. Incidence and prognostic implications of heart block complicating inferior myocardial infarction treated with thrombolytic therapy: results from TIMI II. J Am Coll Cardiol. Sep 1992;20(3):533-40. [Medline].

  5. Sonesson SE, Salomonsson S, Jacobsson LA, et al. Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies. Arthritis Rheum. Apr 2004;50(4):1253-61. [Medline].

  6. Alkoutami GS, Reeves WC, Movahed A. The safety of adenosine pharmacologic stress testing in patients with first-degree atrioventricular block in the presence and absence of atrioventricular blocking medications. J Nucl Cardiol. Sep-Oct 1999;6(5):495-7. [Medline].

  7. Suda K, Raboisson MJ, Piette E, et al. Reversible atrioventricular block associated with closure of atrial septal defects using the Amplatzer device. J Am Coll Cardiol. May 5 2004;43(9):1677-82. [Medline].

  8. Upshaw CB Jr. Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III. J Natl Med Assoc. Jun 2004;96(6):756-60. [Medline].

  9. Mymin D, Mathewson FA, Tate RB, Manfreda J. The natural history of primary first-degree atrioventricular heart block. N Engl J Med. Nov 6 1986;315(19):1183-7. [Medline].

  10. Costello JM, Alexander ME, Greco KM, Perez-Atayde AR, Laussen PC. Lyme carditis in children: presentation, predictive factors, and clinical course. Pediatrics. May 2009;123(5):e835-41. [Medline].

  11. Cheng S, Keyes MJ, Larson MG, McCabe EL, Newton-Cheh C, Levy D, 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].

  12. Makaryus JN, Catanzaro JN, Goldberg S, Makaryus AN. Rapid progression of atrioventricular nodal blockade in a patient with systemic lupus erythematosus. Am J Emerg Med. Oct 2008;26(8):967.e5-7. [Medline].

  13. Berdajs D, Schurr UP, Wagner A, Seifert B, Turina MI, Genoni M. Incidence and pathophysiology of atrioventricular block following mitral valve replacement and ring annuloplasty. Eur J Cardiothorac Surg. Jul 2008;34(1):55-61. [Medline].

  14. Schnittger I, Appleton CP, Hatle LK, Popp RL. Diastolic mitral and tricuspid regurgitation by Doppler echocardiography in patients with atrioventricular block: new insight into the mechanism of atrioventricular valve closure. J Am Coll Cardiol. Jan 1988;11(1):83-8. [Medline].

  15. Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. May 27 2008;51(21):e1-62. [Medline].

 
Previous
Next
 
The PR interval is 0.24 seconds (240 ms) in this patient with asymptomatic first-degree atrioventricular block.
ECG in a patient with first-degree heart block.
ECG in patient with first-degree heart block.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.