Paroxysmal AV Block Natural History, Complications and Prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]
Overview
Natural history most commonly includes recurrent unexplained syncope and presyncope. Complications such as sudden cardian death or indefinite periods of asystole may arise. Prognosis of intrinsic paroxysmal AV block is more dire than extrinsic idiopathic paroxysmal AV block or extrinsic vagal paroxysmal AV block.
Natural History, Complications, and Prognosis
Natural History
- Paroxysmal AV Block is a poorly defined entity.
- The symptoms of paroxysmal AV block can develop at any age (with some studies suggesting a predominance in older individuals) and presents with symptoms such as recurrent unexplained syncope and presyncope, which further manifests on an ECG as intermittent and progressively increasing periods of asystole.
Complications
- Common complications of paroxysmal AV Block include asystole, complete AV Block and sudden cardiac death.
- Complications that can develop as a result of theophylline therapy are nausea, vomiting, abdominal pain, irritability, hallucinations, arrhythmias, acute lung injury and seizures.[1]
- Complications that can develop as a result of cardiac pacing are procedural, component or biophysical interface related. These include hemothroax, pneumothorax,acute thromboembolism, arrhythmia, pericarditis, device battery failure, pulse generator circuit failure, wound dehiscence, erosion, pain and infection.[2]
Prognosis
- Given the presence of an innate structural defect, there is an increase risk of progression to complete AV Block in patients with intrinsic AV block. Sparse literature suggest some correlation between length of asystole and increased severity.[3]
- Given that extrinsic vagally mediated AV block is not associated with an innate conduction defect (seen in intrinsic paroxysmal AV block) and is at the level of the AV node, it is considered benign. [4]
- Given the absence of structural heart disease, the paroxysmal nature of the episodes and the low probability of progression into more severe forms of AV block, extrinsic idiopathic paroxysmal AV block has a good prognosis. [5]
References
- ↑ "StatPearls". 2020. PMID 30422557.
- ↑ Bohora S (2011). "Implantable cardiac pacing devices related complications: keeping pace with time". Indian Pacing Electrophysiol J. 11 (1): 1–4. PMC 3065750. PMID 21468272.
- ↑ Lee S, Wellens HJ, Josephson ME (2009). "Paroxysmal atrioventricular block". Heart Rhythm. 6 (8): 1229–34. doi:10.1016/j.hrthm.2009.04.001. PMID 19632639.
- ↑ Alboni P, Holz A, Brignole M (2013). "Vagally mediated atrioventricular block: pathophysiology and diagnosis". Heart. 99 (13): 904–8. doi:10.1136/heartjnl-2012-303220. PMID 23286970.
- ↑ Guerrero-Márquez FJ, Arana-Rueda E, Pedrote A (2016). "Idiopathic Paroxysmal Atrio-Ventricular Block. What is The Mechanism?". J Atr Fibrillation. 9 (3): 1449. doi:10.4022/jafib.1449. PMC 5368548. PMID 28496928.