Third degree AV block causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Raviteja Guddeti, M.B.B.S. [4]; Hilda Mahmoudi M.D., M.P.H.[5]


Atrioventricular block can be due to congenital or acquired causes. The latter are much more common form and include infectious, inflammatory, degenerative, ischemic, and iatrogenic causes. The degenerative cause are associated with increased age, chronic hypertension, and diabetes mellitus. Infectious cause of atrioventricular block such as lyme carditis may be reversible with medical therapy. Another reversible cause of atrioventricular block including ischemic inferior wall MI due to vagotonic effect should be considered.


The causes of third degree heart block can be broadly divided into acquired and congenital. Many of the acquired causes are the result of Infiltration, fibrosis, or loss of connection in the heart conduction system that can tend to develop heart block.

Congenital form of complete heart block

Common causes of acquired AV block are as follows

  • Drugs:
  • Infectious disease:

  • Degenerative diseases:
  • Rheumatic diseases:
  • Infiltrative pathologies:
  • Neuromuscular disorders:
  • Metabolic abnormality:

  • Toxins:
  • Bradycardia-related block
  • Iatrogenic heart block

Life Threatening Causes

Third degree heart block is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

Medications inducing bradycardia or conduction disorder

Medications that Can Induce/Exacerbate Bradycardia or Conduction Disorders[3]
Anti-hypertensive Anti-arrhythmic Psychoactive Other
• Beta-Adrenergic Receptor Blockers



• Non-dihydropyridine calcium channel blockers


Adenosine .










• Opioid analgesics

• Phenothiazine antiemetics and antipsychotics


Selective Serotonin Reuptake Inhibitors

• Tricyclic Antidepressants

• Anesthetic Drugs (propofol)

Cannabis • Digoxin


• Muscle relaxants (e.g. succinylcholine)

Causes by Organ System

Cardiovascular Acute rheumatic fever, amyloidosis, aspergillosis myocarditis, atrial septal defect, bacterial endocarditis, congenital heart block,[4] coronary ischemia, dilated cardiomyopathy, Ebstein's anomaly, endocardial cushion defect, hypertension,[5] hypertrophic cardiomyopathy, hypertrophic cardiomyopathy alcohol septal ablation,[6] idiopathic heart block,[7][4] idiopathic hypereosinophilic syndrome, mitochondrial myopathy, myocardial infarction,[2] myocarditis, noncompaction cardiomyopathy, tetralogy of fallot, transposition of the great vessels, valvular heart disease, ventricular septal defect
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Arsenic trioxide, Beta-blocker, calcium channel blocker,[8] cardiac glycosides, cholinesterase inhibitor, digitalis, procainamide, quinidine
Ear Nose Throat No underlying causes
Endocrine Amyloidosis, hyperthyroidism,[9]
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Erb's dystrophy, Kearns-Sayre syndrome, nail-patella syndrome
Hematologic Thalassemia major[10]
Iatrogenic Cardiac surgery
Infectious Disease Aspergillosis myocarditis, bacterial endocarditis, Chagas disease, diphtheria,

lyme disease,[11][12][13] varicella zoster

Musculoskeletal/Orthopedic No underlying causes
Neurologic Enhanced vagal tone, idiopathic hypereosinophilic syndrome
Nutritional/Metabolic Amyloidosis, hemochromatosis
Obstetric/Gynecologic No underlying causes
Oncologic Hodgkin disease, multiple myeloma, tumor[14][15]
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol intoxication[16][17]
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Hyperkalemia
Rheumatology/Immunology/Allergy Amyloidosis, ankylosing spondylitis, Becker muscular dystrophy, Churg-Strauss syndrome,[18] degenerative diseases, dermatomyositis, Erb's dystrophy, idiopathic hypereosinophilic syndrome, muscular dystrophy[19] myotonic muscular dystrophy, peroneal muscular atrophy, Reiter's syndrome, relapsing polychondritis,sarcoidosis, scleroderma,[20] neonatal lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Trauma[21][22]

Third degree AV block causes developed by

Causes in Alphabetical Order


  1. Ozcan, Kazim Serhan; Osmonov, Damirbek; Erdinler, Izzet; Altay, Servet; Yildirim, Ersin; Turkkan, Ceyhan; Hasdemir, Hakan; Cakmak, Nazmiye; Alper, Ahmet Taha; Satilmis, Seckin; Gurkan, Kadir (2012). "Atrioventricular block in patients with thyroid dysfunction: Prognosis after treatment with hormone supplementation or antithyroid medication". Journal of Cardiology. 60 (4): 327–332. doi:10.1016/j.jjcc.2012.05.012. ISSN 0914-5087.
  2. 2.0 2.1 2.2 Malla RR, Sayami A (2007). "In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction". JNMA J Nepal Med Assoc. 46 (167): 99–102. PMID 18274563.
  3. 4.0 4.1 4.2 4.3 "Congenital complete atrioventricular". Retrieved 21 August 2013. Text "block. " ignored (help)
  4. 5.0 5.1 Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V (2008). "Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis". J Clin Hypertens (Greenwich). 10 (1): 69–72. PMID 18174773. Unknown parameter |month= ignored (help)
  5. 6.0 6.1 Liu R, Qiao SB, Hu FH, Yang WX, Yuan JS (2012). "[Clinical features of five patients with delayed third degree atrioventricular block after ethanol septal ablation for hypertrophic obstructive cardiomyopathy]". Zhonghua Xin Xue Guan Bing Za Zhi (in Chinese). 40 (12): 1009–11. PMID 23363714. Unknown parameter |month= ignored (help)
  6. 7.0 7.1 Sykes JA, Lubega J, Ezetendu C, Verma R, O'Connor B, Kalyanaraman M (2011). "Asymptomatic complete atrioventricular block in a 13-year-old girl". Pediatr Emerg Care. 27 (11): 1081–3. doi:10.1097/PEC.0b013e3182360674. PMID 22068075. Unknown parameter |month= ignored (help)
  7. 8.0 8.1 Wills BK, Liu JM, Wahl M (2010). "Third-degree AV block [from extended-release diltiazem ingestion in a nine-month-old". J Emerg Med. 38 (3): 328–31. doi:10.1016/j.jemermed.2007.10.053. PMID 18403171. Unknown parameter |month= ignored (help)
  8. 9.0 9.1 Amasyalı B, Barçın C, Kılıç A (2011). "[Supra-His complete atrioventricular block in a patient with subclinical hyperthyroidism]". Turk Kardiyol Dern Ars (in Turkish). 39 (8): 693–6. PMID 22257810. Unknown parameter |month= ignored (help)
  9. 10.0 10.1 Maleki AR, Nikyar B, Hosseini SM (2012). "Third-Degree Heart Block in Thalassemia major: A Case Report". Iran J Pediatr. 22 (2): 260–4. PMC 3446065. PMID 23056897. Unknown parameter |month= ignored (help)
  10. 11.0 11.1 Bhattacharya IS, Dweck M, Francis M (2010). "Lyme carditis: a". J R Coll Physicians Edinb. 40 (2): 121–2. doi:10.4997/JRCPE.2010.207. PMID 21125053. Text "reversible cause of complete atrioventricular block " ignored (help); Unknown parameter |month= ignored (help)
  11. 12.0 12.1 Wagner V, Zima E, Gellér L, Merkely B (2010). "[Acute atrioventricular block in chronic Lyme disease]". Orv Hetil (in Hungarian). 151 (39): 1585–90. doi:10.1556/OH.2010.28965. PMID 20840915. Unknown parameter |month= ignored (help)
  12. 13.0 13.1 Semmler D, Blank R, Rupprecht H (2010). "Complete AV block in Lyme carditis: an important differential diagnosis". Clin Res Cardiol. 99 (8): 519–26. doi:10.1007/s00392-010-0152-8. PMID 20464556. Unknown parameter |month= ignored (help)
  13. 14.0 14.1 Frikha Z, Abid L, Abid D; et al. (2011). "Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report". J Med Case Rep. 5: 433. doi:10.1186/1752-1947-5-433. PMC 3180417. PMID 21892927.
  14. 15.0 15.1 Houchaymi Z, Helou S, Ballout J (2010). "[Pericardial tamponade and third-degree atrioventricular block revealing a primary cardiac lymphoma]". Rev Med Interne (in French). 31 (11): e4–6. doi:10.1016/j.revmed.2010.01.014. PMID 20605278. Unknown parameter |month= ignored (help)
  15. 16.0 16.1 van Cleef AN, Schuurman MJ, Busari JO (2011). "Third-degree atrioventricular block in an adolescent following acute alcohol intoxication". BMJ Case Rep. 2011. doi:10.1136/bcr.07.2011.4547. PMID 22679160.
  16. 17.0 17.1 Brvar M, Bunc M (2009). "High-degree atrioventricular block in acute ethanol poisoning: a case report". Cases J. 2: 8559. doi:10.4076/1757-1626-2-8559. PMC 2769457. PMID 19918387.
  17. 18.0 18.1 Tian Z, Fang Q, Zhao DC; et al. (2010). "[The clinico-pathological manifestation of cardiac involvement in eosinophilic diseases]". Zhonghua Nei Ke Za Zhi (in Chinese). 49 (8): 684–7. PMID 20979789. Unknown parameter |month= ignored (help)
  18. 19.0 19.1 Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ (2012). "Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit". Rev Esp Cardiol. doi:10.1016/j.recesp.2012.08.011. PMID 23194837. Unknown parameter |month= ignored (help)
  19. 20.0 20.1 Femenía F, Arce M, Arrieta M (2010). "[Systemic sclerosis complicated with syncope and complete AV block]". Medicina (B Aires) (in Spanish; Castilian). 70 (5): 442–4. PMID 20920962.
  20. 21.0 21.1 Thakar S, Chandra P, Pednekar M, Kabalkin C, Shani J (2012). "Complete heart block following a blow on the chest by a soccer ball: a rare manifestation of commotio cordis". Ann Noninvasive Electrocardiol. 17 (3): 280–2. doi:10.1111/j.1542-474X.2012.00518.x. PMID 22816548. Unknown parameter |month= ignored (help)
  21. 22.0 22.1 Portet N, Riu B, Bounes V, Minville V, Fourcade O (2012). "Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma". J Emerg Med. 43 (6): e385–8. doi:10.1016/j.jemermed.2010.11.059. PMID 21621364. Unknown parameter |month= ignored (help)

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