eMedicine Specialties > Emergency Medicine > Cardiovascular
Heart Block, First Degree: Follow-up
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
John AD, Fleisher LA. Electrocardiography: the ECG. Anesthesiol Clin. Dec 2006;24(4):697-715, v-vi. [Medline].
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].
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].
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].
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].
Further Reading
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
Follow-up: Heart Block, First Degree