Paroxysmal AV Block echocardiography
2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Recommendations for Cardiac Imaging
| Recommendations for Cardiac Imaging |
| "1. In patients with newly identified LBBB, seconddegree Mobitz type II atrioventricular block,high-grade atrioventricular block, or hirddegree atrioventricular block with or without apparent structural heart disease or coronary artery disease, transthoracic echocardiography is recommended. (Level of Evidence: B-NR[1]
2. In selected patients presenting with bradycardia or conduction disorders other than LBBB, second-degree Mobitz type II atrioventricular block, high-grade atrioventricular block, or third-degree atrioventricular block, transthoracic echocardiography is reasonable if structuralheart disease is suspected. (Level of Evidence: B-NR)[1] 3. In selected patients with bradycardia or bundle branch block, disease-specific advanced imaging (eg, transesophageal echocardiography, computed tomography,cardiac magnetic resonance imaging [MRI], or nuclear imaging) is reasonable if structural heart disease is suspected yet not confirmed by other diagnostic modalities. (Level of Evidence: C-LD)[1] 4. In the evaluation of patients with asymptomatic sinus bradycardia or firstdegree atrioventricular block and no clinical evidence of structural heart disease, routine cardiac imaging is not indicated. (Level of Evidence: B-NR)[1]" |
- The ACCF/ASE/AHA/ASNC/HFSA/ HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography endorses the propriety of echocardiography in patients with symptoms suspected to be cardiac in origin, including symptoms potentially caused by bradycardia or conduction disorders such as syncope, or lightheadedness /presyncope with signs or symptoms of cardiovascular disease known to cause such symptoms (eg, aortic stenosis, hypertrophic cardiomyopathy or heart failure).
- Transthoracic echocardiography can identify various structural cardiac abnormalities underlying bradycardia or conduction disturbance, including cardiomyopathy, valvular heart disease, congenital anomalies, tumors, infections, infiltrative processes, immunologically mediated conditions, and diseases of the great vessels and pericardium.
- However, the yield is higher when there are clinical indications of structural disease, including in patients with syncope who manifest signs or symptoms of cardiac disease (eg, bradycardia or conduction disorders).
- Transthoracic echocardiography can be prognostic, as well, both in those presenting with syncope and in those who are less profoundly symptomatic.
- Transesophageal echocardiography can be a useful adjunct for endocarditis with or without perivalvular complications, aortic dissection, or unruptured sinus of Valsalva aneurysm which have all been occasionally associated with bradycardia or conduction block. [1]
- ↑ 1.0 1.1 1.2 1.3 1.4 Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: 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): 932–987. doi:10.1016/j.jacc.2018.10.043. PMID 30412710.