eMedicine Specialties > Cardiology > Arrhythmias

Third-Degree Atrioventricular Block: Follow-up

Author: Adam S Budzikowski, MD, PhD, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Electrophysiology Section, State University of New York-Downstate, University Hospital of Brooklyn
Coauthor(s): Andrew C Corsello, MD, Consulting Staff, Department of Internal Medicine, Division of Cardiology, Cardiovascular Consultants of Maine, PA; James P Daubert, MD, Associate Professor of Medicine, Director of Electrophysiology Service, University of Rochester Medical Center; Consulting Staff, Atrial Fibrillation Clinic and Adult Congenital Heart Clinic, University of Rochester Medical Center, Strong Memorial Hospital; Abrar H Shah, MD, Consulting Staff, Department of Medicine-Cardiology, Strong Memorial Hospital, Geneva General Hospital; Consulting Staff, Department of Cardiology, Highland Hospital; Consulting Staff, Department of Cardiology and Electrophysiology, Park Ridge Hospital
Contributor Information and Disclosures

Updated: Jun 17, 2009

Follow-up

Further Inpatient Care

Patients can be discharged from the hospital the following day after pacemaker implantation. Routinely, chest radiography is required before discharge.

Further Outpatient Care

Routine postpacemaker care is necessary. This includes transtelephonic checks every 2 months and office visits for pacemaker interrogation every 6-12 months. In the initial period post implantation, these visits are more frequent.

Complications

  • Some patients may develop polymorphic ventricular tachycardia when significant bradycardia is present. This is related to prolongation of repolarization with extremely slow rates. This mechanism is also mostly responsible for death in these patients.
  • The complications related to pacemaker insertion are rare (<1%).

Prognosis

When treated with permanent pacing, the prognosis is excellent.

Miscellaneous

Medicolegal Pitfalls

  • Failure to correctly diagnose heart block and treat appropriately
  • Failure to inform patients about regulations regarding driving for patients with syncope, which vary from state to state
 


More on Third-Degree Atrioventricular Block

Overview: Third-Degree Atrioventricular Block
Differential Diagnoses & Workup: Third-Degree Atrioventricular Block
Treatment & Medication: Third-Degree Atrioventricular Block
Follow-up: Third-Degree Atrioventricular Block
Multimedia: Third-Degree Atrioventricular Block
References
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References

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  3. Ma TS, Collins TC, Habib G, Bredikis A, Carabello BA. Herpes zoster and its cardiovascular complications in the elderly--another look at a dormant virus. Cardiology. 2007;107:63-7. [Medline]. [Full Text].

  4. Abuin G, Nieponice A, Barcelo A, Rojas-Granados A, Leu PH, Arteaga-Martinez M. Anatomical reasons for the discrepancies in atrioventricular block after inferior myocardial infarction with and without right ventricular involvement. Tex Heart Inst J. 2009;36(1):8-11. [Medline].

  5. Nguyen HL, Lessard D, Spencer FA, Yarzebski J, Zevallos JC, Gore JM. Thirty-year trends (1975-2005) in the magnitude and hospital death rates associated with complete heart block in patients with acute myocardial infarction: a population-based perspective. Am Heart J. Aug 2008;156(2):227-33. [Medline].

  6. Merin O, Ilan M, Oren A, Fink D, Deeb M, Bitran D. Permanent pacemaker implantation following cardiac surgery: indications and long-term follow-up. Pacing Clin Electrophysiol. Jan 2009;32(1):7-12. [Medline].

  7. [Guideline] Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS. ACC/AHA/HRS 2008 guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: executive summary. Heart Rhythm. Jun 2008;5(6):934-55. [Medline].

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Further Reading

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Keywords

third-degree atrioventricular block, third-degree AV block, AV block, heart block, complete AV block, complete heart block, first-degree AV block, 3rd degree heart block, third-degree heart block, cardiomyopathy, mitral calcification, aortic calcification, endocarditis, sudden cardiac death, SCD, Lenègre disease, Lev disease, rheumatic fever, myocarditis, Chagas disease, Lyme borreliosis, Aspergillus myocarditis, ankylosing spondylitis, Reiter syndrome, relapsing polychondritis, rheumatoid arthritis, scleroderma, amyloidosis, sarcoidosis, tumors, Hodgkin disease, multiple myeloma, Becker muscular dystrophy, myotonic muscular dystrophy, myocardial infarction, MI, hypoxia, hyperkalemia, AV dissociation, atrioventricular dissociation, pacemaker, implantable cardioverter-defibrillator, implantable cardioverter/defibrillator, ICD, neuromuscular disease, myotonic dystrophy, Duchenne muscular dystrophy, iatrogenic heart block

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Contributor Information and Disclosures

Author

Adam S Budzikowski, MD, PhD, Assistant Professor of Medicine, Division of Cardiovascular Medicine, Electrophysiology Section, State University of New York-Downstate, University Hospital of Brooklyn
Adam S Budzikowski, MD, PhD is a member of the following medical societies: American College of Cardiology, European Society of Cardiology, and Polish Society of Cardiology
Disclosure: Nothing to disclose.

Coauthor(s)

Andrew C Corsello, MD, Consulting Staff, Department of Internal Medicine, Division of Cardiology, Cardiovascular Consultants of Maine, PA
Disclosure: Nothing to disclose.

James P Daubert, MD, Associate Professor of Medicine, Director of Electrophysiology Service, University of Rochester Medical Center; Consulting Staff, Atrial Fibrillation Clinic and Adult Congenital Heart Clinic, University of Rochester Medical Center, Strong Memorial Hospital
James P Daubert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Heart Rhythm Society
Disclosure: Medtronic Equity interest None; Boston Scientific Honoraria Speaking and teaching; CV Therapeutics Consulting fee Consulting; Cryocor Consulting fee Consulting

Abrar H Shah, MD, Consulting Staff, Department of Medicine-Cardiology, Strong Memorial Hospital, Geneva General Hospital; Consulting Staff, Department of Cardiology, Highland Hospital; Consulting Staff, Department of Cardiology and Electrophysiology, Park Ridge Hospital
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: Nothing to disclose.

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.

 
 
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