eMedicine Specialties > Emergency Medicine > Cardiovascular

Heart Block, First Degree: Follow-up

Author: Michael D Levine, MD, Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center
Coauthor(s): David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital
Contributor Information and Disclosures

Updated: Mar 9, 2009

Follow-up

Further Inpatient Care

  • In general, hospitalization specifically for first-degree atrioventricular (AV) block is not indicated. However, admission may be indicated for associated conditions (eg, myocardial infarction). Patients with a marked first-degree AV block (PR >300 msec) can present with symptoms similar to the pacemaker syndrome.2  In these individuals, admission may be indicated.
  • Significant electrolyte abnormalities should be corrected.

Further Outpatient Care

  • In the absence of a disease process that requires admission, patients with first-degree AV block may be safely discharged and receive follow-up on an outpatient basis.
  • Patients should get serial follow-up ECGs to evaluate for progression to a higher-grade AV block.
  • Patients with first-degree AV block and coexistent bundle-branch block should be closely observed.

Complications

  • Patients with first-degree block can occasionally progress to higher-grade AV blocks. Usually, such a progression is only to a Mobitz type I, second-degree heart block, but occasionally, higher-grade block can occur. The later scenario is particularly seen in patients with an acute MI, myocarditis, or acute drug overdoses.
  • Drugs that slow conduction through the AV nodal system increase the risk of progression to higher-grade heart blocks. Administering such agents to a person with a coexisting first-degree AV block should be done with caution.

Prognosis

  • The prognosis for isolated first-degree atrioventricular (AV) block is very good. Progression from isolated first-degree heart block to high-degree block is very uncommon.5
 


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References
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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. 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].

  5. 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].

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Further Reading

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Keywords

heart block, first-degree heart block, first degree heart block, arrhythmia, cardiac arrhythmia, abnormal heart rhythm, atrioventricular block, first-degree atrioventricular block, AV block, first-degree AV block, prolongation of the PR interval, P wave, PR interval

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Contributor Information and Disclosures

Author

Michael D Levine, MD, Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center
Michael D Levine, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, 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: Schering  Honoraria Speaking and teaching

Medical Editor

Theodore J Gaeta, DO, MPH, FACEP, Clinical Associate Professor, Department of Emergency Medicine, Joan and Sanford Weill Medical College at Cornell University; 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: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eddy Lang, MDCM, CCFP (EM), CSPQ, Assistant Professor, Department of Family Medicine, McGill University; Consulting Staff, Department of Emergency Medicine, The Sir Mortimer B Davis-Jewish General Hospital
Eddy Lang, MDCM, CCFP (EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD, Assistant Professor, Department of Medicine, Division of Emergency Medicine, Harvard Medical School; Associate-Chief, Attending Physician, 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: Schering  Honoraria Speaking and teaching

 
 
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