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==[[Paroxysmal AV block historical perspective|Historical Perspective]]==
==[[Paroxysmal AV block historical perspective|Historical Perspective]]==
*There is limited information about the historical perspective of paroxysmal AV block.
*Adolph Sachs et al reported one of the first cases on paroxysmal AV block in 1931. The patient had presented with multiple spells of palpitations, hot flashes, dizziness, ringing in the ears, weakness and diaphoresis accompanied by convulsions. During an acute episode, he noticed an irregular ventricular rhythm, irregular complexes and given a time interval of 30 seconds, the ventricle would beat once in the first 15 second window and 4-5 times in the succeeding window.  It was noticed that the duration of the block progressively increased until it was present all the time. Mitral valvulitis was put down as the cause of the attack and the fact that a response to atropine does not rule out an intrinsic conduction defect was emphasized. <ref name="urlParoxysmal complete auriculo-ventricular heart-block: A case report - ScienceDirect">{{cite web |url=https://www.sciencedirect.com/science/article/abs/pii/S000287033390722X |title=Paroxysmal complete auriculo-ventricular heart-block: A case report - ScienceDirect |format= |work= |accessdate=}}</ref>
*In 1972, Philippe Coumel et al hypothesized that the cause of bradycardia/pause dependent AV block was the spontaneous depolarization of specialized conducting fibers in the late stages of diastole. It was during this ‘zone of opportunity’ that they noticed this ‘AV dissociation’. In this case, they found that the block occurred to be proximal to the division of the His bundle. <ref name="urlBradycardia-dependent atrio-ventricular block: Report of two cases of A-V block elicited by premature beats - ScienceDirect">{{cite web |url=https://www.sciencedirect.com/science/article/abs/pii/S0022073671800109 |title=Bradycardia-dependent atrio-ventricular block: Report of two cases of A-V block elicited by premature beats - ScienceDirect |format= |work= |accessdate=}}</ref>
*In 1997. Brignole et al first described EI AVB in a group of 15 syncope patients with an initial negative work up. They fortuitously stumbled upon ECG findings indicating a paroxysmal AV block and reconfirmed this by performing an adenosine triphosphate test in each patient. <ref name="pmid9403616">{{cite journal |vauthors=Brignole M, Gaggioli G, Menozzi C, Gianfranchi L, Bartoletti A, Bottoni N, Lolli G, Oddone D, Del Rosso A, Pellinghelli G |title=Adenosine-induced atrioventricular block in patients with unexplained syncope: the diagnostic value of ATP testing |journal=Circulation |volume=96 |issue=11 |pages=3921–7 |date=December 1997 |pmid=9403616 |doi=10.1161/01.cir.96.11.3921 |url=}}</ref>


==[[Paroxysmal AV block classification|Classification]]==
==[[Paroxysmal AV block classification|Classification]]==

Revision as of 07:46, 13 June 2020

Paroxysmal AV block Microchapters

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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]

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Overview

Historical Perspective

  • There is limited information about the historical perspective of paroxysmal AV block.
  • Adolph Sachs et al reported one of the first cases on paroxysmal AV block in 1931. The patient had presented with multiple spells of palpitations, hot flashes, dizziness, ringing in the ears, weakness and diaphoresis accompanied by convulsions. During an acute episode, he noticed an irregular ventricular rhythm, irregular complexes and given a time interval of 30 seconds, the ventricle would beat once in the first 15 second window and 4-5 times in the succeeding window. It was noticed that the duration of the block progressively increased until it was present all the time. Mitral valvulitis was put down as the cause of the attack and the fact that a response to atropine does not rule out an intrinsic conduction defect was emphasized. [1]
  • In 1972, Philippe Coumel et al hypothesized that the cause of bradycardia/pause dependent AV block was the spontaneous depolarization of specialized conducting fibers in the late stages of diastole. It was during this ‘zone of opportunity’ that they noticed this ‘AV dissociation’. In this case, they found that the block occurred to be proximal to the division of the His bundle. [2]
  • In 1997. Brignole et al first described EI AVB in a group of 15 syncope patients with an initial negative work up. They fortuitously stumbled upon ECG findings indicating a paroxysmal AV block and reconfirmed this by performing an adenosine triphosphate test in each patient. [3]

Classification

Pathophysiology

Causes

Differentiating Paroxysmal AV block from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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  1. "Paroxysmal complete auriculo-ventricular heart-block: A case report - ScienceDirect".
  2. "Bradycardia-dependent atrio-ventricular block: Report of two cases of A-V block elicited by premature beats - ScienceDirect".
  3. Brignole M, Gaggioli G, Menozzi C, Gianfranchi L, Bartoletti A, Bottoni N, Lolli G, Oddone D, Del Rosso A, Pellinghelli G (December 1997). "Adenosine-induced atrioventricular block in patients with unexplained syncope: the diagnostic value of ATP testing". Circulation. 96 (11): 3921–7. doi:10.1161/01.cir.96.11.3921. PMID 9403616.