Atrioventricular block - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Atrioventricular (AV) block can be described by degree (based on ECG appearance) or by anatomic level of block.
The degree of AV block or anatomic level of block does not necessarily correlate with the severity of subsequent symptoms.
The goals of therapy are to treat symptoms and to prevent syncope and sudden cardiac death due to very slow or absent ventricular rates.
Patients with advanced AV block (usually type II second-degree, third-degree, or infranodal AV block) of irreversible cause should undergo permanent pacemaker placement.

First-degree AV block

Courtesy of Dr Susan F. Kim, Dr John F. Beshai, and Dr Stephen L. Archer; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

First-degree AV block
Type I second-degree AV block. This figure demonstrates typical features of the AV Wenckebach, including progressively shortening R-R intervals as the P-R intervals lengthen; the figure also shows grouped beating, which is also typical for AV Wenckebach
Type II second-degree AV block
Third-degree AV block
Third-degree heart block: right bundle-branch block escape
Baseline ECG for a patient with third-degree AV block
2:1 AV block
Tachy-brady syndrome due to sinus node disease. Ventricular rate is slow intermittently, but AV block is not seen
Patient with 2:1 AV block, status post permanent pacemaker placement

Citations

Key Articles

Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019 Aug 20;140(8):e382-482.[Abstract][Full Text]
Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Heart Rhythm. 2012 Oct;9(10):1737-53.[Abstract][Full Text]
Glikson M, Nielsen JC, Kronborg MB, et al; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021 Sep 14;42(35):3427-520.[Abstract][Full Text]

Referenced Articles

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