Infra-Hisian Block: Difference between revisions

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==Risk factors==
==Risk factors==


* Common risk factors associated with second degree AV block include the following:<ref name="pmid11988196">{{cite journal| author=Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A | display-authors=etal| title=Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. | journal=Am J Cardiol | year= 2002 | volume= 89 | issue= 9 | pages= 1062-6 | pmid=11988196 | doi=10.1016/s0002-9149(02)02276-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988196  }}</ref><ref name="pmid119881962">{{cite journal| author=Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A | display-authors=etal| title=Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. | journal=Am J Cardiol | year= 2002 | volume= 89 | issue= 9 | pages= 1062-6 | pmid=11988196 | doi=10.1016/s0002-9149(02)02276-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988196  }}</ref><ref name="pmid31125096">{{cite journal |vauthors=Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, Kenttä TV, Rissanen H, Vittinghoff E, Knekt P, Heliövaara M, Huikuri HV, Marcus GM |title=Risk Factors Associated With Atrioventricular Block |journal=JAMA Netw Open |volume=2 |issue=5 |pages=e194176 |date=May 2019 |pmid=31125096 |pmc=6632153 |doi=10.1001/jamanetworkopen.2019.4176 |url=}}</ref><ref name="pmid8447272">{{cite journal |vauthors=Schoeller R, Andresen D, Büttner P, Oezcelik K, Vey G, Schröder R |title=First- or second-degree atrioventricular block as a risk factor in idiopathic dilated cardiomyopathy |journal=Am. J. Cardiol. |volume=71 |issue=8 |pages=720–6 |date=March 1993 |pmid=8447272 |doi=10.1016/0002-9149(93)91017-c |url=}}</ref>
* Common [[risk factors]] [[Association (statistics)|associated]] with [[second degree AV block]] include the following:<ref name="pmid11988196">{{cite journal| author=Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A | display-authors=etal| title=Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. | journal=Am J Cardiol | year= 2002 | volume= 89 | issue= 9 | pages= 1062-6 | pmid=11988196 | doi=10.1016/s0002-9149(02)02276-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988196  }}</ref><ref name="pmid119881962">{{cite journal| author=Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A | display-authors=etal| title=Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. | journal=Am J Cardiol | year= 2002 | volume= 89 | issue= 9 | pages= 1062-6 | pmid=11988196 | doi=10.1016/s0002-9149(02)02276-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988196  }}</ref><ref name="pmid31125096">{{cite journal |vauthors=Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, Kenttä TV, Rissanen H, Vittinghoff E, Knekt P, Heliövaara M, Huikuri HV, Marcus GM |title=Risk Factors Associated With Atrioventricular Block |journal=JAMA Netw Open |volume=2 |issue=5 |pages=e194176 |date=May 2019 |pmid=31125096 |pmc=6632153 |doi=10.1001/jamanetworkopen.2019.4176 |url=}}</ref><ref name="pmid8447272">{{cite journal |vauthors=Schoeller R, Andresen D, Büttner P, Oezcelik K, Vey G, Schröder R |title=First- or second-degree atrioventricular block as a risk factor in idiopathic dilated cardiomyopathy |journal=Am. J. Cardiol. |volume=71 |issue=8 |pages=720–6 |date=March 1993 |pmid=8447272 |doi=10.1016/0002-9149(93)91017-c |url=}}</ref>
** Intrinsic atrioventricular node disease
**[[Intrinsic factor|Intrinsic]] [[atrioventricular node]] [[disease]]
** Myocarditis
**[[Myocarditis]]
** Acute myocardial infarction  
**[[Acute myocardial infarction]]
** Prior cardiac surgery  
** Prior [[cardiac surgery]]
** Older age
** Older [[age]]
** Heart attack or coronary artery disease
**[[Heart attack]] or [[coronary artery disease]]
** Cardiomyopathy
**[[Cardiomyopathy]]
** Sarcoidosis
**[[Sarcoidosis]]
** Lyme disease
**[[Lyme disease]]
** High potassium levels
** High [[potassium]] levels
** Severe hypothyroidism
** Severe [[hypothyroidism]]
** Certain inherited neuromuscular diseases
** Certain [[inherited]] [[Neuromuscular disease|neuromuscular diseases]]
** Medicines that slow the heart rate
**[[Medicine|Medicines]] that [[slow]] the [[heart rate]]
** After open heart surgery
** After [[open heart surgery]]


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==

Revision as of 20:59, 22 April 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Sara Mohsin, M.D.[2]

Overview

Infra-Hisian blocks are defined as impaired conduction in the electrical system of the heart that occur below the AV node.

Historical perspective

Classification

Classification of Infra-Hisian Block
Types of Infra-Hisian Block Sub-type
Type 2 second degree heart block (Mobitz II) _
Left bundle branch block Left anterior fascicular block
Left posterior fascicular block
Right bundle branch block _

Pathophysiology

  • Mobitz type II second degree AV block, in which the PR interval remains unchanged prior to a P wave that fails to conduct to the ventricles.
  • It almost always results from conduction system disease below the level of the AV node, occurring in the bundle of His in approximately 20 percent of cases and in the bundle branches in the remainder.
  • Patients with bundle branch involvement also have axis shifts and QRS widening depending upon the location of the block.
  • In addition, at least two-thirds of patients with this disorder also have bifascicular or even trifascicular disease.
  • Mobitz type I and Mobitz type II second degree AV block cannot be differentiated from the ECG when 2:1 AV block is present.
  • In this situation, every other P wave is non-conducted and there is no opportunity to observe for the constant PR interval that is characteristic of Mobitz type II second degree AV block.
  • Conduction delay in Mobitz type II second degree block is almost always infra-nodal (His bundle [20%], bundle branches or fascicles).
  • Usually the morphology of the QRS complex is wide, except when the site of block is the His bundle.
  • In this variant of second degree heart block the PR interval is constant with occasional dropped beats as compared to the gradually prolonging PR interval in Mobitz type I.
  • Bifascicular or trifascicular disease is seen in two thirds of the patients with Mobitz type II.[2][3]
  • Type 2 second degree AV block, also known as Mobitz II is almost always a disease of the distal conduction system (His-Purkinje System).
  • Although the terms infranodal block or infrahisian block are often applied to this disorder, they are not synonymous with it.
  • Infranodal block and infra-Hisian block are terms which refer to the anatomic location of the block, whereas
  • Mobitz II refers to an electrocardiographic pattern associated with block at these levels.[4]

Causes

The potential etiologies of Mobitz type II second degree AV block include reversible (both pathologic and iatrogenic) and idiopathic causes that are similar to other degrees of AV block (table 1). Common potentially reversible causes include:

●Pathologic – Myocardial ischemia (acute or chronic) involving the conduction system, cardiomyopathy (eg, amyloidosis, sarcoidosis), myocarditis (eg, Lyme disease), endocarditis with abscess formation, hyperkalemia, and hypervagotonia.

●Iatrogenic – Medication-related (AV nodal blocking medications), post-cardiac surgery, post-catheter ablation, post-transcatheter aortic valve implantation.

Mobitz type II second degree AV block is rarely seen in patients without underlying heart disease. When identifiable, the reversible causes most commonly associated with Mobitz type II second degree AV block are myocardial infarction with ischemia of the AV node and medications that alter conduction through the AV node (eg, digoxin, beta blockers, calcium channel blockers). When no specific reversible cause is identified, the block is often felt to be related to idiopathic progressive cardiac conduction disease with myocardial fibrosis and/or sclerosis that affects the conduction system.

Major causes of atrioventricular (AV) block
Physiologic and pathophysiologic
Increased vagal tone
Ischemic heart disease, including acute myocardial infarction
Progressive cardiac conduction system disease With fibrosis and/or sclerosis (Lenegre disease)
With calcification (Lev disease)
Infections (eg, viral myocarditis, Lyme carditis)
Cardiomyopathy Infiltrative processes (eg, sarcoidosis, amyloidosis, hemochromatosis, malignancy, etc)
Other non-ischemic cardiomyopathies (eg, idiopathic, infectious, etc)
Congenital AV block Related to structural congenital heart disease
As part of neonatal lupus syndrome
Other Hyperkalemia
severe hypo- or hyperthyroidism
trauma
degenerative neuromuscular diseases
Iatrogenic
Drugs Beta blockers
calcium channel blockers
digoxin
antiarrhythmic drugs
adenosine
Transcatheter aortic valve implantation
Cardiac surgery Post valvular surgery
post surgical correction of congenital heart disease
Catheter ablation of arrhythmias
Alcohol septal ablation for hypertrophic cardiomyopathy
Transcatheter closure of ventricular septal defect

Life Threatening Causes

Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated[7].

Common Causes

Causes by Organ System

Cardiovascular Acute myocardial infarction, acute rheumatic fever, ASD, dilated cardiomyopathy, Ebstein's anomaly, hypersensitive carotid sinus syndrome, hypertension, hypertrophic cardiomyopathy, Lev's disease, myocardial bridging, myocarditis, normal variants, post aortic valve replacement, post catheter ablation for arrhythmias, post closure of a ventricular septal defect, post mitral valve replacement, tetralogy of Fallot, endocardial cushion defect, transposition of the great vessels, valvular heart disease, VSD
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amiodarone, beta-blockers, digitalis, calcium channel blockers, cholinesterase inhibitors, disopyramide, dofetilide, dolasetron, donepezil, eslicarbazepine acetate, fesoterodine, fingolimod, flecainide, ibutilide, lacosamide, magnesium, paliperidone, pramipexole, procainamide, propafenone, propoxyphene, quinidine, sotalol, terodiline
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism, myxedema, thyrotoxic periodic paralysis
Environmental Hypothermia
Gastroenterologic Hemochromatosis
Genetic Emery-Dreifuss muscular dystrophy, Fabry disease, glycogenosis type 2b, hereditary neuromuscular disease, Kearns-Sayre syndrome
Hematologic Multiple myeloma Lymphoma[11]
Iatrogenic Post aortic valve replacement, post catheter ablation for arrhythmias, post closure of a ventricular septal defect, post mitral valve replacement
Infectious Disease Acute rheumatic fever, Chagas disease, diphtheria, Lyme disease, myocarditis, neonatal lupus erythematosus, protozoal infection, sarcoidosis, SLE, tuberculosis
Musculoskeletal / Ortho Ankylosing spondylitis, hereditary neuromuscular disease, Kearns-Sayre syndrome, mitochondrial genome inherited conditions, muscular dystrophy
Neurologic Enhanced vagal tone
Nutritional / Metabolic Fabry disease, glycogenosis type 2b
Obstetric/Gynecologic No underlying causes
Oncologic Multiple myeloma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal / Electrolyte Hyperkalemia, hypokalemia
Rheum / Immune / Allergy Ankylosing spondylitis, dermatomyositis, rheumatoid arthritis, scleroderma, SLE
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Amyloidosis, degenerative diseases

Causes in Alphabetical Order

Epidemiology and Demographics

Prevalence

  • In the United States, the prevalence of second-degree AV block is believed to be 3 in 100,000 individual.[12]
  • Nearly 3% of patients with underlying structural heart disease develop some form of second-degree AV block. The male-to-female ratio of second-degree AV block is 1:1.

Gender

  • Men and women are affected equally by second degree AV block.

Risk factors

Natural History, Complications, and Prognosis

Natural History

  • Mobitz II second degree Av block is due to block inferior to the AV node (infra-Hisian structures) and it progresses to complete heart block.[17]

Complications

Prognosis

  • Mobitz II, as it involves the infra nodal structures, carries the risk of progression to complete heart block and carries an unfavorable prognosis.[13]

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

  • Patients with Mobitz II can appear asymptomatic as well. However, in more cases they may be in distress or progress to the more severe third degree AV block.
  • Patients may appear pale in cases of bradycardia with decreased cardiac output.[23]
  • Bradycardia with an irregular pulse[24]
  • Lightheadedness
  • Hypotension[25]
  • Syncope or presyncope
  • Jugular venous distension
  • Bibasilar crackles in patients with exacerbated heart failure
  • Peripheral edema

Laboratory Findings

Patients with second degree AV block should be checked for the following laboratory tests:[26]

Electrocardiogram

  • There are intermittent blocked P waves
  • In the conducted beats, the PR intervals remain constant
  • The PR is fairly constant except that slight shortening may occur in the first beat after the blocked cycle. This is the result of improved conduction following the block
  • Most patients with type II second-degree AV block have associated bundle branch block.
  • In these instances the block is usually located distal to the His bundle, in approximately 27 to 35% of patients however, the lesion is located in the His bundle itself, and a narrow complex may be inscribed.
  • 2:1 AV Block:
  • Impossible to determine whether the second-degree AV block is type I or type II.
  • A long rhythm strip is helpful to document any change in the behavior of the conduction ratio
  • When the atrial rate is increased by exercise or by atropine, the AV block in type I tends to decrease and that in type II tends to increase

Shown below is an electrocardiogram of a 12 lead EKG with a 2:1 AV block.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

Shown below is an electrocardiogram of a type II second degree AV block (Mobitz type II).

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page

Treatment

Medical therapy for Mobitz II

Contraindicated medications

Second degree AV block(except in patients with a functioning artificial pacemaker)[29][30] is considered an absolute contraindication to the use of the following medications:

Surgery for Mobitz II

  • Type II Mobitz (symptomatic or asymptomatic) is by itself an indication for insertion of a pacemaker. Other indications include[32][33]:
  • Implantation of permanent pacemakers in both asymptomatic and symptomatic patients is usually done. Asymptomatic Mobitz II are prone to be converted to symptomatic or third degree heart block. Thus, they should be considered for a pacemaker even if asymptomatic.
  • A dual chamber DDD pacemaker is preferred over a single chambered VVI pacemakers as it maintains physiologic AV synchrony.
  • A dual-chamber artificial pacemaker is a type of device that typically listens for a pulse from the SA node and sends a pulse to the AV node at an appropriate interval, essentially completing the connection between the two nodes. Pacemakers in this role are usually programmed to enforce a minimum heart rate and to record instances of atrial flutter and atrial fibrillation.

Prevention

Primary Prevention

  • Effective treatment of hypertension and maintenance of normal blood glucose levels may be useful strategies in preventing AV block.

Differentiating Infra-Hisian Block From Other Diseases


Arrhythmia Rhythm Rate P wave PR Interval QRS Complex Response to Maneuvers Epidemiology Co-existing Conditions
Atrioventricular block[34] First degree [35][36]
  • Regular
  • Normal
  • Prolonged PR interval (>200 msec)
  • Less than 0.12 seconds, consistent, and normal in morphology.
  • No treatment required
  • Prevalence: 650 to 1600 per 100,000 individuals in the united states.
Second degree[12][37]
  • Regular irregular
  • Normal
  • Mobtiz I: Progressive PR prolongation
  • Mobitz II: Normal PR interval
 QRS is normal but dropped as the following:
  • Mobitz I: QRS complex is dropped after a progressive lengthening of PR
  • Mobitz II: QRS complex is dropped after a normal PR
  • Can be reversed by using a pacemaker.
  • Prevalence: 3 per 100,000 individuals in the united states.
Third degree[38][39]
  • Regular
  • Normal but no relationship between P wave and the QRS.
  • More P waves than the QRS complexes.
  • Varies
  • Normal QRS
  • Can be reversed by using a pacemaker.
  • The prevalence: 20 per 100,000 individuals worldwide.
Atrial Fibrillation (AFib)[40][41]
  • Irregularly irregular
  • Absent
  • Fibrillatory waves
  • Absent
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • 2.7–6.1 million people in the United States have AFib
  • 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib
Atrial Flutter[42]
  • Regular or Irregular
  • 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common
  • Sawtooth pattern of P waves at 250 to 350 bpm
  • Biphasic deflection in V1
  • Varies depending upon the magnitude of the block, but is short
  • Less than 0.12 seconds, consistent, and normal in morphology
  • Conduction may vary in response to drugs and maneuvers dropping the rate from 150 to 100 or to 75 bpm
Atrioventricular nodal reentry tachycardia (AVNRT)[43][44][45][46]
  • Regular
  • 140-280 bpm
  • Slow-Fast AVNRT:
    • Pseudo-S wave in leads II, III, and AVF
    • Pseudo-R' in lead V1.
  • Fast-Slow AVNRT
  • Slow-Slow AVNRT
  • Inverted, superimposed on or buried within the QRS complex (pseudo R prime in V1/pseudo S wave in inferior leads)
  • Absent (P wave can appear after the QRS complex and before the T wave, and in atypical AVNRT, the P wave can appear just before the QRS complex)
  • Less than 0.12 seconds, consistent, and normal in morphology in the absence of aberrant conduction
  • QRS alternans may be present
Multifocal Atrial Tachycardia[47][48]
  • Irregular
  • Atrial rate is > 100 beats per minute
  • Varying morphology from at least three different foci
  • Absence of one dominant atrial pacemaker, can be mistaken for atrial fibrillation if the P waves are of low amplitude
  • Less than 0.12 seconds, consistent, and normal in morphology
Paroxysmal Supraventricular Tachycardia
  • Regular
  • 150 and 240 bpm
  • Absent
  • Hidden in QRS
  • Absent
  • Narrow complexes (< 0.12 s)
Premature Atrial Contractrions (PAC)[49][50]
  • Regular except when disturbed by premature beat(s)
  • 80-120 bpm
  • Upright
  • > 0.12 second
  • May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node
  • Ashman’s Phenomenon:
  • Usually narrow (< 0.12 s)
Wolff-Parkinson-White Syndrome[51][52]
  • Regular
  • Atrial rate is nearly 300 bpm and ventricular rate is at 150 bpm
  • Less than 0.12 seconds
  • A delta wave and evidence of ventricular pre-excitation if there is conduction to the ventricle via ante-grade conduction down an accessory pathway
  • A delta wave and pre-excitation may not be present because bypass tracts do not conduct ante-grade.
Ventricular Fibrillation (VF)[53][54][55]
  • Irregular
  • 150 to 500 bpm
  • Absent
  • Absent
  • Absent (R on T phenomenon in the setting of ischemia)
Ventricular Tachycardia[56][57]
  • Regular
  • > 100 bpm (150-200 bpm common)
  • Absent
  • Absent
  • Initial R wave in V1, initial r > 40 ms in V1/V2, notched S in V1, initial R in aVR, lead II R wave peak time ≥50 ms, no RS in V1-V6, and atrioventricular dissociation
  • Wide complex, QRS duration > 120 milliseconds
  • 5-10% of patients presenting with AMI

References

  1. ↑ Upshaw CB, Silverman ME (2000). "John Hay: discoverer of type II atrioventricular block". Clin Cardiol. 23 (11): 869–71. doi:10.1002/clc.4960231118. PMC 6655013 Check |pmc= value (help). PMID 11097138.
  2. ↑ Puech P, Wainwright RJ (1983). "Clinical electrophysiology of atrioventricular block". Cardiol Clin. 1 (2): 209–24. PMID 6544636.
  3. ↑ 3.0 3.1 3.2 3.3 Wogan JM, Lowenstein SR, Gordon GS (1993). "Second-degree atrioventricular block: Mobitz type II". J Emerg Med. 11 (1): 47–54. doi:10.1016/0736-4679(93)90009-v. PMID 8445186.
  4. ↑ 4.0 4.1 4.2 Li X, Xue Y, Wu H (2018). "A Case of Atrioventricular Block Potentially Associated with Right Coronary Artery Lesion and Ticagrelor Therapy Mediated by the Increasing Adenosine Plasma Concentration". Case Rep Vasc Med. 2018: 9385017. doi:10.1155/2018/9385017. PMC 5933017. PMID 29850368.
  5. ↑ 5.0 5.1 Fu Md J, Bhatta L (2018). "Lyme carditis: Early occurrence and prolonged recovery". J Electrocardiol. 51 (3): 516–518. doi:10.1016/j.jelectrocard.2017.12.035. PMID 29275956.
  6. ↑ Tuohy S, Saliba W, Pai M, Tchou P (January 2018). "Catheter ablation as a treatment of atrioventricular block". Heart Rhythm. 15 (1): 90–96. doi:10.1016/j.hrthm.2017.08.015. PMID 28823599.
  7. ↑ 7.0 7.1 7.2 7.3 Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty |title= (help)
  8. ↑ Misumida N, Ogunbayo GO, Kim SM, Abdel-Latif A, Ziada KM, Elayi CS (November 2018). "Frequency and Significance of High-Degree Atrioventricular Block and Sinoatrial Node Dysfunction in Patients With Non-ST-Elevation Myocardial Infarction". Am. J. Cardiol. 122 (10): 1598–1603. doi:10.1016/j.amjcard.2018.08.001. PMID 30227965.
  9. ↑ 9.0 9.1 9.2 Barold SS, Herweg B (December 2012). "Second-degree atrioventricular block revisited". Herzschrittmacherther Elektrophysiol. 23 (4): 296–304. doi:10.1007/s00399-012-0240-8. PMID 23224264.
  10. ↑ Kamatani T, Akizuki A, Kondo S, Shirota T (Fall 2016). "Second-Degree Atrioventricular Block Occurring After Tooth Extraction". Anesth Prog. 63 (3): 156–9. doi:10.2344/15-00042.1. PMC 5011958. PMID 27585419.
  11. ↑ Menicagli F, Lanza A, Sbrocca F, Baldi A, Spugnini EP (2016). "A case of advanced second-degree atrioventricular block in a ferret secondary to lymphoma". Open Vet J. 6 (1): 68–70. doi:10.4314/ovj.v6i1.10. PMC 4833871. PMID 27200273.
  12. ↑ 12.0 12.1 Zehender M, Meinertz T, Keul J, Just H (1990). "ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance". Am Heart J. 119 (6): 1378–91. doi:10.1016/s0002-8703(05)80189-9. PMID 2191578.
  13. ↑ 13.0 13.1 13.2 Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A; et al. (2002). "Frequency, predictors, and consequences of atrioventricular block after mitral valve repair". Am J Cardiol. 89 (9): 1062–6. doi:10.1016/s0002-9149(02)02276-2. PMID 11988196.
  14. ↑ Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A; et al. (2002). "Frequency, predictors, and consequences of atrioventricular block after mitral valve repair". Am J Cardiol. 89 (9): 1062–6. doi:10.1016/s0002-9149(02)02276-2. PMID 11988196.
  15. ↑ Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ, Kenttä TV, Rissanen H, Vittinghoff E, Knekt P, Heliövaara M, Huikuri HV, Marcus GM (May 2019). "Risk Factors Associated With Atrioventricular Block". JAMA Netw Open. 2 (5): e194176. doi:10.1001/jamanetworkopen.2019.4176. PMC 6632153 Check |pmc= value (help). PMID 31125096.
  16. ↑ Schoeller R, Andresen D, Büttner P, Oezcelik K, Vey G, Schröder R (March 1993). "First- or second-degree atrioventricular block as a risk factor in idiopathic dilated cardiomyopathy". Am. J. Cardiol. 71 (8): 720–6. doi:10.1016/0002-9149(93)91017-c. PMID 8447272.
  17. ↑ Rodstein M, Wolloch L, Iuster Z (1979). "The natural history intraventricular conduction disturbances in the aged: an analysis of the developing second and third degree heart block with clinical pathological correlations". Am. J. Med. Sci. 277 (2): 179–88. doi:10.1097/00000441-197903000-00006. PMID 463945.
  18. ↑ 18.0 18.1 Bexton RS, Camm AJ (March 1984). "Second degree atrioventricular block". Eur. Heart J. 5 Suppl A: 111–4. doi:10.1093/eurheartj/5.suppl_a.111. PMID 6373268.
  19. ↑ Thiruganasambandamoorthy V, Hess EP, Turko E, Tran ML, Wells GA, Stiell IG (July 2012). "Defining abnormal electrocardiography in adult emergency department syncope patients: the Ottawa Electrocardiographic Criteria". CJEM. 14 (4): 248–58. PMID 22813399.
  20. ↑ Barold SS, Van Heuverswyn FE, Timmers L, Stroobandt RX (August 2014). "Mobitz type II second-degree atrioventricular block during dobutamine stress echocardiography. True or false?". Echocardiography. 31 (7): 799–801. doi:10.1111/echo.12577. PMID 25080840.
  21. ↑ 21.0 21.1 Kashou AH, Goyal A, Nguyen T, Chhabra L. PMID 29083636. Missing or empty |title= (help)
  22. ↑ Zeppilli P, Fenici R, Sassara M, Pirrami MM, Caselli G (September 1980). "Wenckebach second-degree A-V block in top-ranking athletes: an old problem revisited". Am. Heart J. 100 (3): 281–94. doi:10.1016/0002-8703(80)90140-4. PMID 7405798.
  23. ↑ Rosen KM, Dhingra RC, Loeb HS, Rahimtoola SH (1973). "Chronic heart block in adults. Clinical and electrophysiological observations". Arch Intern Med. 131 (5): 663–72. PMID 4701376.
  24. ↑ Schneider MD, Roller DH, Morganroth J, Josephson ME (July 1978). "The syndromes of familial atrioventricular block with sinus bradycardia: prognostic indices, electrophysiologic and histopathologic correlates". Eur J Cardiol. 7 (5–6): 337–51. PMID 699934.
  25. ↑ Trappe HJ (September 2016). "[Consciousness disorders from cardiological view]". Dtsch. Med. Wochenschr. (in German). 141 (19): 1361–9. doi:10.1055/s-0042-103177. PMID 27642736.
  26. ↑ Gupta PK, Lichstein E, Chadda KD (1976). "Chronic His bundle block. Clinical, electrocardiographic, electrophysiological, and follow-up studies on 16 patients". Br Heart J. 38 (12): 1343–9. doi:10.1136/hrt.38.12.1343. PMC 483178. PMID 1008977.
  27. ↑ Steere AC, McHugh G, Damle N, Sikand VK (2008). "Prospective study of serologic tests for lyme disease". Clin Infect Dis. 47 (2): 188–95. doi:10.1086/589242. PMC 5538270. PMID 18532885.
  28. ↑ Schernthaner C, Kraus J, Danmayr F, Hammerer M, Schneider J, Hoppe UC, Strohmer B (March 2016). "Short-term pacemaker dependency after transcatheter aortic valve implantation". Wien. Klin. Wochenschr. 128 (5–6): 198–203. doi:10.1007/s00508-015-0906-4. PMID 26745972.
  29. ↑ Brignole M, Deharo JC, Guieu R (August 2015). "Syncope and Idiopathic (Paroxysmal) AV Block". Cardiol Clin. 33 (3): 441–7. doi:10.1016/j.ccl.2015.04.012. PMID 26115830.
  30. ↑ Kelkar PN (August 1998). "Atenolol induced high grade AV block". J Assoc Physicians India. 46 (8): 748, 751. PMID 11229299.
  31. ↑ Zeltser D, Justo D, Halkin A, Rosso R, Ish-Shalom M, Hochenberg M, Viskin S (July 2004). "Drug-induced atrioventricular block: prognosis after discontinuation of the culprit drug". J. Am. Coll. Cardiol. 44 (1): 105–8. doi:10.1016/j.jacc.2004.03.057. PMID 15234417.
  32. ↑ Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD (August 2019). "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". J. Am. Coll. Cardiol. 74 (7): e51–e156. doi:10.1016/j.jacc.2018.10.044. PMID 30412709.
  33. ↑ Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM (May 1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–9. doi:10.1161/01.cir.63.5.1043. PMID 7471363.
  34. ↑ Kerola T, Eranti A, Aro AL, Haukilahti MA, Holkeri A, Junttila MJ; et al. (2019). "Risk Factors Associated With Atrioventricular Block". JAMA Netw Open. 2 (5): e194176. doi:10.1001/jamanetworkopen.2019.4176. PMC 6632153 Check |pmc= value (help). PMID 31125096.
  35. ↑ Barold SS (1996). "Indications for permanent cardiac pacing in first-degree AV block: class I, II, or III?". Pacing Clin Electrophysiol. 19 (5): 747–51. doi:10.1111/j.1540-8159.1996.tb03355.x. PMID 8734740.
  36. ↑ Upshaw CB (2004). "Comparison of the prevalence of first-degree atrioventricular block in African-American and in Caucasian patients: an electrocardiographic study III". J Natl Med Assoc. 96 (6): 756–60. PMC 2568382. PMID 15233485.
  37. ↑ Friedman HS, Gomes JA, Haft JI (1975). "An analysis of Wenckebach periodicity". J Electrocardiol. 8 (4): 307–15. doi:10.1016/s0022-0736(75)80003-3. PMID 1176840.
  38. ↑ OSTRANDER LD, BRANDT RL, KJELSBERG MO, EPSTEIN FH (June 1965). "ELECTROCARDIOGRAPHIC FINDINGS AMONG THE ADULT POPULATION OF A TOTAL NATURAL COMMUNITY, TECUMSEH, MICHIGAN". Circulation. 31: 888–98. doi:10.1161/01.cir.31.6.888. PMID 14297523.
  39. ↑ Movahed MR, Hashemzadeh M, Jamal MM (October 2005). "Increased prevalence of third-degree atrioventricular block in patients with type II diabetes mellitus". Chest. 128 (4): 2611–4. doi:10.1378/chest.128.4.2611. PMID 16236932.
  40. ↑ Lankveld TA, Zeemering S, Crijns HJ, Schotten U (July 2014). "The ECG as a tool to determine atrial fibrillation complexity". Heart. 100 (14): 1077–84. doi:10.1136/heartjnl-2013-305149. PMID 24837984.
  41. ↑ Harris K, Edwards D, Mant J (2012). "How can we best detect atrial fibrillation?". J R Coll Physicians Edinb. 42 Suppl 18: 5–22. doi:10.4997/JRCPE.2012.S02. PMID 22518390.
  42. ↑ Cosío FG (June 2017). "Atrial Flutter, Typical and Atypical: A Review". Arrhythm Electrophysiol Rev. 6 (2): 55–62. doi:10.15420/aer.2017.5.2. PMC 5522718. PMID 28835836.
  43. ↑ Katritsis DG, Josephson ME (August 2016). "Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia". Arrhythm Electrophysiol Rev. 5 (2): 130–5. doi:10.15420/AER.2016.18.2. PMC 5013176. PMID 27617092.
  44. ↑ Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T (April 2010). "Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway". Acta Cardiol. 65 (2): 171–6. doi:10.2143/AC.65.2.2047050. PMID 20458824.
  45. ↑ "Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf".
  46. ↑ Schernthaner C, Danmayr F, Strohmer B (2014). "Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias". Med Princ Pract. 23 (6): 543–50. doi:10.1159/000365418. PMC 5586929. PMID 25196716.
  47. ↑ Scher DL, Arsura EL (September 1989). "Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment". Am. Heart J. 118 (3): 574–80. doi:10.1016/0002-8703(89)90275-5. PMID 2570520.
  48. ↑ Goodacre S, Irons R (March 2002). "ABC of clinical electrocardiography: Atrial arrhythmias". BMJ. 324 (7337): 594–7. doi:10.1136/bmj.324.7337.594. PMC 1122515. PMID 11884328.
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  50. ↑ Strasburger JF, Cheulkar B, Wichman HJ (December 2007). "Perinatal arrhythmias: diagnosis and management". Clin Perinatol. 34 (4): 627–52, vii–viii. doi:10.1016/j.clp.2007.10.002. PMC 3310372. PMID 18063110.
  51. ↑ Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
  52. ↑ Rosner MH, Brady WJ, Kefer MP, Martin ML (November 1999). "Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues". Am J Emerg Med. 17 (7): 705–14. doi:10.1016/s0735-6757(99)90167-5. PMID 10597097.
  53. ↑ Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J (September 2016). "Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction". J Geriatr Cardiol. 13 (9): 789–797. doi:10.11909/j.issn.1671-5411.2016.09.006. PMC 5122505. PMID 27899944.
  54. ↑ Samie FH, Jalife J (May 2001). "Mechanisms underlying ventricular tachycardia and its transition to ventricular fibrillation in the structurally normal heart". Cardiovasc. Res. 50 (2): 242–50. doi:10.1016/s0008-6363(00)00289-3. PMID 11334828.
  55. ↑ Adabag AS, Luepker RV, Roger VL, Gersh BJ (April 2010). "Sudden cardiac death: epidemiology and risk factors". Nat Rev Cardiol. 7 (4): 216–25. doi:10.1038/nrcardio.2010.3. PMC 5014372. PMID 20142817.
  56. ↑ Koplan BA, Stevenson WG (March 2009). "Ventricular tachycardia and sudden cardiac death". Mayo Clin. Proc. 84 (3): 289–97. doi:10.1016/S0025-6196(11)61149-X. PMC 2664600. PMID 19252119.
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