Second degree AV block surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]
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Surgery
Mobitz I
Indications for implantation of a pacemaker include:
- Symptomatic bradycardia
- Heart failure
- Asystole for more than 3 sec
- Pseudopacemaker syndrome: Rarely second degree type I AV block can present with symptoms similar to pacemaker syndrome. In such cases placement of a pacemaker is warranted.
Dual chamber DDD pacing mode is usually employed in patients with Mobitz I and symptomatic bradycardia. This mode maintains the normal physiologic synchrony between the atria and the ventricles unlike the single chamber VVI mode.
Mobitz II
- Type II Mobitz (symptomatic or asymptomatic) is by itself an indication for insertion of a pacemaker. Other indications include:
- Myotonic dystrophy
- Kearns-Sayre syndrome
- Erb's dystrophy
- Peroneal muscular atrophy. These neuromuscular disorders have a high potential for unpredictable rapid progression to complete heart block.
- Implantation of permanent pacemakers in both asymptomatic and symptomatic patients is usually done. Asymptomatic Mobitz II are prone to be converted to symptomatic or third degree heart block. Thus, they should be considered for a pacemaker even if asymptomatic.
- A dual chamber DDD pacemaker is preferred over a single chambered VVI pacemakers as it maintains physiologic AV synchrony.
- A dual-chamber artificial pacemaker is a type of device that typically listens for a pulse from the SA node and sends a pulse to the AV node at an appropriate interval, essentially completing the connection between the two nodes. Pacemakers in this role are usually programmed to enforce a minimum heart rate and to record instances of atrial flutter and atrial fibrillation.