eMedicine Specialties > Cardiology > Arrhythmias

Second-Degree Atrioventricular Block: Follow-up

Author: Ali A Sovari, MD, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois at Chicago
Coauthor(s): Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago; Raluca B Arimie, MD, Assistant Professor of Internal Medicine, Department of Medicine, Division of Cardiology, University of California at Los Angeles; Consulting Staff, Santa Monica Cardiology; Ryan L Cooley, MD, Consulting Staff, Heart Care Associates LLC, Wisconsin Electrophysiology Group; Assistant Professor, Department of Medicine, University of Wisconsin Medical School at Milwaukee
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Further Inpatient Care

  • If high-grade AV block and, possibly, symptoms due to AV block are present, consider monitoring the patient and then performing Holter monitoring or treadmill testing in the future. If the AV block occurs at night, consider sleep apnea as the cause.
  • Second-degree block at the AV nodal level may be due to digoxin, beta-blockers, or calcium channel blockers. Decreasing the dose and/or discontinuing these medications may restore normal AV conduction.

Miscellaneous

Medicolegal Pitfalls

  • Common pitfalls to avoid when diagnosing second-degree AV block are as follows:
    • Failure to recognize nonconducted atrial premature beats as the apparent cause
    • Failure to consider atypical type I block during an apparent narrow QRS type II block
    • Failure to consider vagally induced AV block, ie, vomiting, sleep apnea
    • Failure to realize that AV nodal and infranodal block almost never occur in the same electrocardiogram or Holter recording
    • Belief that all type I blocks are AV nodal in nature
    • Failure to consider concealed extrasystoles as a cause of pseudo-AV block (ie, observing for the common association of sudden PR-interval prolongation due to retrograde penetration of the extrasystole into the AV node and isolated retrograde P waves from retrograde conduction to the atrium)
  • Relying solely on a computer-rendered ECG diagnosis: Computer interpretations are notoriously error-prone.
 


More on Second-Degree Atrioventricular Block

Overview: Second-Degree Atrioventricular Block
Differential Diagnoses & Workup: Second-Degree Atrioventricular Block
Treatment & Medication: Second-Degree Atrioventricular Block
Follow-up: Second-Degree Atrioventricular Block
Multimedia: Second-Degree Atrioventricular Block
References
[ CLOSE WINDOW ]

References

  1. Zehendet M, Meinertz T, Keul J, Just H. ECG variants and cardiac arrthymias in athletes: clinical relevance and prognostic importance. Am heart J. Jun 1990;119(6):1378-91. [Medline].

  2. Makaryus JN, Catanzaro JN, Friedman ML, Katoma KC, Makaryus AN. Persistent second-degree atrioventricular block following adenosine infusion for nuclear stress testing. J Cardiovasc Med. Mar 2008;9(3):304-7. [Medline].

  3. Van Herendael B, Van Herendael H, De Raedt H. Second-degree atrioventricular block as the first sign of sarcoidosis ina previously asymptomatic patient. Acta Cardiol. Jun 2007;62(3):299-301. [Medline].

  4. Lev M. Anatomic basis for atrioventricular block. Am J Med. Nov 1964;37:742-8. [Medline].

  5. Hsu YJ, Lin YF, Chau T, et al. Electrocardiographic manifestations in patients with thyrotoxic periodic paralysis. Am J Med Sci. Sep 2003;326(3):128-32. [Medline].

  6. Vinsonneau U, Delluc A, Bergez C, Caumes D, Talarmin F. [Second degree atrioventricular block in mixed connective tissue disease]. Rev Med Interne. Aug 2005;26(8):656-60. [Medline].

  7. den Dulk K, Brugada P, Braat S, Heddle B, Wellens HJ. Myocardial bridging as a cause of paroxysmal atrioventricular block. J Am Coll Cardiol. Mar 1983;1(3):965-9. [Medline].

  8. Lin SM, Hwang HK, Chen MR. Amplatzer septal occluder-induced transient complete atrioventricular block. J Formos Med Assoc. Dec 2007;106(12):1052-6. [Medline].

  9. Thanopoulos BD, Rigby ML. Outcome of transcatheter closure of muscular ventricular septal defects with the Amplatzer ventricular septal defect occluder. Heart. Apr 2005;91(4):513-6. [Medline].

  10. Arias MA, Sanchez AM. Obstructive sleep apnea and its relationship to cardiac arrhythmias. J Cardiovasc Electrophysiol. Sep 2007;18(9):1006-14. [Medline].

  11. Sovari AA, Bodine CK, Farokhi F. Cardiovascular manifestations of myotonic dystrophy-1. Cardiol Rev. Jul-Aug 2007;15(4):191-4. [Medline].

  12. Gregoratos, G, Abrams, J, Epstein, AE, et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/NASPE committee to update the 1998 pacemaker guidelines). Circulation. Oct 2002;106(16):2145-61. [Medline].

  13. [Guideline] Epstein AE, DiMarco JP, Ellenbogen KA, 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]. [Full Text].

  14. Barold SS, Hayes DL. Second-degree atrioventricular block: a reappraisal. Mayo Clin Proc. Jan 2001;76(1):44-57. [Medline].

  15. Denes P, Levy L, Pick A, Rosen KM. The incidence of typical and atypical A-V Wenckebach periodicity. Am Heart J. Jan 1975;89(1):26-31. [Medline].

  16. Fisch C, DeSanctis RW, Dodge HT. Guidelines for Clinical Intracardiac Electrophysiologic Studies. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. Circulation. Dec 1989;80(6):1925-39. [Medline].

  17. [Guideline] Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). J Cardiovasc Electrophysiol. Nov 2002;13(11):1183-99. [Medline].

  18. [Guideline] Gregoratos G, Cheitlin MD, Conill A, et al. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Executive Summary--a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). Circulation. Apr 7 1998;97(13):1325-35. [Medline].

  19. [Guideline] Hayes DL, Barold SS, Camm AJ, Goldschlager NF. Evolving indications for permanent cardiac pacing: an appraisal of the 1998 American College of Cardiology/American Heart Association Guidelines. Am J Cardiol. Nov 1 1998;82(9):1082-6, A6. [Medline].

  20. Lange HW, Ameisen O, Mack R, et al. Prevalence and clinical correlates of non-Wenckebach, narrow-complex second-degree atrioventricular block detected by ambulatory ECG. Am Heart J. Jan 1988;115(1 Pt 1):114-20. [Medline].

  21. Massie B, Scheinman MM, Peters R, et al. Clinical and electrophysiologic findings in patients with paroxysmal slowing of the sinus rate and apparent Mobitz type II atrioventricular block. Circulation. Aug 1978;58(2):305-14. [Medline].

  22. Puesch P, Grolleau R, Guimond C. Incidence of different types of A-V block and their localization by His bundle recordings. In: Wellens HJJ, Lie KI, Janse MJ, eds. The Conduction System of the Heart. Philadelphia, Pa: Stenfert Kroese; 1976:. 467-84.

  23. Rardon D, Miles W, Zipes D. Atrioventricular block and dissociation. In: Zipes D, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:. 451-8.

  24. Royer A, van Veen TA, Le Bouter S, Marionneau C, Griol-Charhbili V, Leoni AL, et al. Mouse model of SCN5A-linked hereditary Lenegre's disease: age-related conduction slowing and myocardial fibrosis. Circulation. Apr 12 2005;111(14):1738-46. [Medline].

  25. Schwartzman D. Atrioventricular block and Atrioventricular dissociation. In: Zipes D, Jalife J, eds. Cardiac Electrophysiology: From Cell to Bedside. 4th. 2004;485-7.

  26. Tan HL, Bink-Boelkens MT, Bezzina CR, Viswanathan PC, Beaufort-Krol GC, van Tintelen PJ, et al. A sodium-channel mutation causes isolated cardiac conduction disease. Nature. Feb 22 2001;409(6823):1043-7. [Medline].

  27. Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M, et al. Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug. J Am Coll Cardiol. Jul 7 2004;44(1):105-8. [Medline].

  28. Zipes DP. Second-degree atrioventricular block. Circulation. Sep 1979;60(3):465-72. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

second-degree atrioventricular block, heart block, 2nd degree heart block, second-degree AV block, 2nd degree AV block, AV block, Mobitz AV block, Mobitz heart block, Mobitz type I, Mobitz type II, Wenckebach phenomenon, Wenckebach heart block, high-grade AV block, complete heart block, third-degree AV block, Stokes-Adams syncopal attack, heart failure, angina, acute myocardial infarction, sinus slowing, cardioactive drugs, endocarditis, myocarditis, Lyme disease, acute rheumatic fever, amyloidosis, hemochromatosis, sarcoidosis, hyperkalemia, hypermagnesemia, Addison disease, ankylosing spondylitis, dermatomyositis, rheumatoid arthritis, scleroderma, lupus erythematosus, Reiter syndrome, progressive idiopathic fibrosis of the cardiac skeleton, aortic stenosis, aortic valve replacement surgery, muscular dystrophies, corrective congenital heart surgery

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Ali A Sovari, MD, Clinical and Research Fellow in Cardiovascular Medicine, Section of Cardiology, University of Illinois at Chicago
Ali A Sovari, MD is a member of the following medical societies: American College of Physicians and American Heart Association
Disclosure: Nothing to disclose.

Coauthor(s)

Abraham G Kocheril, MD, FACC, FACP, Professor of Medicine, Director of Clinical Electrophysiology, University of Illinois at Chicago
Abraham G Kocheril, MD, FACC, FACP is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, Cardiac Electrophysiology Society, Central Society for Clinical Research, Heart Failure Society of America, and Illinois State Medical Society
Disclosure: Nothing to disclose.

Raluca B Arimie, MD, Assistant Professor of Internal Medicine, Department of Medicine, Division of Cardiology, University of California at Los Angeles; Consulting Staff, Santa Monica Cardiology
Disclosure: Nothing to disclose.

Ryan L Cooley, MD, Consulting Staff, Heart Care Associates LLC, Wisconsin Electrophysiology Group; Assistant Professor, Department of Medicine, University of Wisconsin Medical School at Milwaukee
Ryan L Cooley, MD is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert E Fowles, MD, Clinical Professor of Medicine, University of Utah College of Medicine; Consulting Staff, Intermountain Medical Center and LDS Hospital; Director and Consulting Staff, Department of Cardiology, Salt Lake Clinic
Robert E Fowles, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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

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

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
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.