Third degree AV block screening
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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] Aditya Ganti M.B.B.S. [3]
Overview
Ambulatory electrocardiographic monitoring is useful for finding intermittent atrioventricular block, LBBB and bifascicular block in asymptomatic patients. In patients with symptomatic atrioventricular block or bradycardia during sleep, screening about sleep apnea is recommended.
Screening
- Ambulatory electrocardiographic monitoring is useful for finding intermittent atrioventricular block, LBBB and bifascicular block in asymptomatic patients.
- In patients with symptomatic atrioventricular block or bradycardia during sleep, screening about sleep apnea is recommended.[1]
Recommendations for screening sleep apnea in patients with bradycardia or conduction disorder |
(Class I, Level of Evidence B): |
❑ Screening about sleep apnea syndrome is recommended In patients with documented or suspected bradycardia or conduction disorder during sleep |
(Class IIa, Level of Evidence B): |
❑ In patients with previously PPM implantation for bradycardia or conduction disorder, screening about sleep apnea syndrome is reasonable |
The above table adopted from 2018 AHA/ACC/HRS Guideline[2] |
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- There is insufficient evidence to recommend routine screening for third degree AV block. However, screening for congenital AV block is recommended.
- Recommendations include echocardiogram for newborns of pregnant women with SSA autoantiboides.
- Timing for screening:[3]
- Women with history of neonatal lupus, fetal echos are recommended weekly then repeating the echos every 3 or 4 weeks.
- Women with prior infant with lupus, echos are performed at the 16 weeks of gestation or 18 weeks.
- Fetal echos can be stopped by the 23 weeks of gestation.
References
- ↑ Kasai, Takatoshi; Floras, John S.; Bradley, T. Douglas (2012). "Sleep Apnea and Cardiovascular Disease". Circulation. 126 (12): 1495–1510. doi:10.1161/CIRCULATIONAHA.111.070813. ISSN 0009-7322.
- ↑ Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (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". Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.
- ↑ Clowse MEB, Eudy AM, Kiernan E, Williams MR, Bermas B, Chakravarty E; et al. (2018). "The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices". Rheumatology (Oxford). 57 (suppl_5): v9–v17. doi:10.1093/rheumatology/key141. PMC 6099126. PMID 30137589.