eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiology

Atrioventricular Block, Second Degree: Follow-up

Author: M Silvana Horenstein, MD, Consultant, Pediatric and Fetal Cardiac Diagnostic, Diagnostico Gineco-Obstetrico, PC; Associate Medical Director, Legacy Department, Best Doctors, Inc
Coauthor(s): Robert Murray Hamilton, MD, MSc, FRCPC, Section Head, Electrophysiology, Director, High-Risk Hereditary Heart Conditions Clinic, Labatt Family Heart Centre; Professor, Department of Pediatrics, Associate Scientist, Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, University of Toronto, Canada
Contributor Information and Disclosures

Updated: Sep 19, 2008

Follow-up

Further Inpatient Care

  • Infusion of inotropes and temporary pacing are usually performed in a suitable hospital environment with facilities for continuous nursing and monitoring.

Further Outpatient Care

  • Patients receiving a permanent pacemaker should have arrangements for repeat pacemaker assessment in 6-12 weeks, in 6 months, and biannually or annually, depending on their pacemaker mode, time from implant, and pacemaker dependency.
  • Patients without a pacemaker but with the potential for progression of atrioventricular (AV) block severity should receive periodic monitoring, including ECG and Holter monitoring. This is particularly important for patients with mitochondrial disorders, such as Kearns-Sayre syndrome, who may develop rapid and unpredictable progression of AV block.

Transfer

  • Transfer of patients with second-degree AV block should include attained intravenous (IV) access, available short-term medications and pacing systems, and accompaniment by individuals familiar with the administration of these medications and application of these systems.

Deterrence/Prevention

  • In patients with synchronous temporary or permanent pacing systems in place, avoid sources of electromagnetic interference, such as electrocautery or magnetic resonance imaging.

Prognosis

  • With the severe infantile form of long-QT syndrome, the prognosis is very guarded, even if patients are treated with beta blockade, pacing, and stellate ganglionectomy. The prognosis of patients with high-grade AV block is similar to that of patients with complete AV block.

Patient Education

  • Discuss the possibility of permanent pacing systems early with patients who are likely to require them. This allows patients and their families sufficient time to accommodate the concept of living with a pacemaker. Identify misconceptions and dispel myths (which are often present) related to living with a pacemaker.
 


More on Atrioventricular Block, Second Degree

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Treatment & Medication: Atrioventricular Block, Second Degree
Follow-up: Atrioventricular Block, Second Degree
Multimedia: Atrioventricular Block, Second Degree
References
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References

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Further Reading

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Keywords

atrioventricular, AV, second-degree atrioventricular block, second-degree AV block, Mobitz I AV block, Wenckebach AV block, Mobitz II AV block, non-Wenckebach AV block, heart block, third-degree atrioventricular block, dilated cardiomyopathy, syncope, presyncope, irregular pulse, heart failure, hepatomegaly, peripheral edema, neonatal lupus erythematosus, myocarditis, endocarditis, Lyme disease, rheumatic fever, hyperthyroidism, thyroid disease, corrected transposition of the great arteries, atrial septal defect, Duchenne muscular dystrophy, rhabdomyoma, acute rheumatic heart disease, Lyme carditis, cardiac dystrophies, lipodystrophies, premature aging syndromes, Kearns-Sayre syndrome, sickle cell disease, drug-induced torsade de pointes

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Contributor Information and Disclosures

Author

M Silvana Horenstein, MD, Consultant, Pediatric and Fetal Cardiac Diagnostic, Diagnostico Gineco-Obstetrico, PC; Associate Medical Director, Legacy Department, Best Doctors, Inc
M Silvana Horenstein, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert Murray Hamilton, MD, MSc, FRCPC, Section Head, Electrophysiology, Director, High-Risk Hereditary Heart Conditions Clinic, Labatt Family Heart Centre; Professor, Department of Pediatrics, Associate Scientist, Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, University of Toronto, Canada
Robert Murray Hamilton, MD, MSc, FRCPC is a member of the following medical societies: American Heart Association, Canadian Cardiovascular Society, Canadian Medical Association, Canadian Medical Protective Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Ontario Medical Association, Pediatric Electrophysiology Society, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Charles I Berul, MD, Associate Professor of Pediatrics, Harvard Medical School; Senior Associate, Department of Cardiology, Children's Hospital of Boston
Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Heart Rhythm Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Alvin J Chin, MD, Professor of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine
Alvin J Chin, MD is a member of the following medical societies: American Association for the Advancement of Science and American Heart Association
Disclosure: Nothing to disclose.

CME Editor

Gilbert Herzberg, MD, Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College
Gilbert Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Chief Editor

Steven R Neish, MD, SM, Director of Pediatric Cardiology Fellowship Program, Associate Professor, Department of Pediatrics, Baylor College of Medicine
Steven R Neish, MD, SM is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, and American Heart Association
Disclosure: Nothing to disclose.

 
 
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