Atrioventricular Block Medication

Updated: Nov 14, 2017
  • Author: Chirag M Sandesara, MD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Medication

Medication Summary

Long-term medical therapy is not indicated in atrioventricular (AV) block. As noted earlier, permanent pacing is the therapy of choice in symptomatic AV block with bradycardia.

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Anticholinergic Agents

Class Summary

The goal of administering anticholinergic agents is to improve conduction through the atrioventricular node (AVN) by reducing vagal tone via muscarinic receptor blockade. This is only effective if the site of block is within the AVN. For patients with suspected infranodal block, this therapy is ineffective and may make the level of the block worse if it is in the His bundle or below.

Atropine IV/IM (Atropair, Atropisol)

Atropine increases AV conduction by reducing vagal tone via muscarinic receptor blockade; this may improve AV conduction if the block is in the AV node but atropine is ineffective in infranodal block and may worsen the block. An insufficient dose may cause paradoxical slowing of the heart rate.

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Beta1/Beta2 Adrenergic Agonists

Isoproterenol (Isuprel)

Isoproterenol binds and stimulates beta-receptors of the heart, smooth and skeletal muscle, vasculature, and alimentary tract. It has positive inotropic and chronotropic actions.

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Vasopressors, Alpha/Beta Agonists

Class Summary

For hemodynamically unstable patients with AV block, intravenous dopamine or dobutamine should be started to improve chronotropic and inotropic cardiac function.. 

Dopamine (Intropin)

Intravenous dopamine infusion typically begins at a dose of 3 mcg/kg/minute and can be titrated up to 20 mcg/kg/minute for heart rate and blood pressure augmentation.

Dobutamine

Intravenous dobutamine infusion typically begins at a dose of 5 mcg/kg/minute and can be titrated up to 20 mcg/kg/minute.

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