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Mobitz I AV Block: Why and When to Pace?

  • R. Cazzin
  • P. Golia
  • G. Di Fonzo
Conference paper

Abstract

The presence of symptoms related to bradyarrhythmia is one of the basic conditions in which there is general agreement in favor of permanent cardiac pacemaker implantation. In patients with Mobitz I atrioventricular (AV) block, clinical manifestations such as transient dizziness, light-headedness, near-syncope, or more generalized symptoms related to exercise tolerance or congestive heart failure, are considered a class I indication for permanent pacing in the guidelines of 1991 ACC/AHA Task Force [1]. In the same guidelines, pacing in asymptomatic subjects with Mobitz type I AV block is indicated, with some divergence of opinion (class II condition), only if an intra- or infra-His bundle block is demonstrated, while there is no indication (class III condition) when the block is at nodal level. In these guidelines relief of symptoms is the only therapeutic goal of pacing, while other aims, such as improved outcome, are not considered since the prognostic role of pacing in the Mobitz I AV block has not yet been fully assessed.

Keywords

Atrioventricular Block Structural Heart Disease Pacemaker Implantation Underlying Heart Disease Nodal Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Dreifus LS, Gillette PC, Fisch C et al (1991) Guidelines for implantation of cardiac pacemakers and anti-arrhythmia devices: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Terapeutic Cardiovascular Procedures (Committee on Pacemaker Implantation). J Am Coll Cardiol 18:1–13PubMedCrossRefGoogle Scholar
  2. 2.
    Warton JM, Ellenbogen KA (1995) Atrioventricular conduction system disease. In: Ellenbogen KA, Kay GH, Wilkoff BL (eds) Clinical cardiac pacing. Saunders, Philadelphia, pp 691–703Google Scholar
  3. 3.
    Denes P (1987) Atrioventricular and intraventricular block. Circulation 75[Suppl III]:19–25Google Scholar
  4. 4.
    Hiss RG, Lamb LE (1962) Electrocardiography findings in 122,043 individuals. Circulation 25:947PubMedCrossRefGoogle Scholar
  5. 5.
    Aronow WS, Epstein S, Swartz KS et al (1987) Prevalence of arrhythmias detected by ambulatory electrocardiographic monitoring and of abnormal left ventricular ejection fraction in person older than 62 years in a long-term health care facility. Am J Cardiol 59:368–369PubMedCrossRefGoogle Scholar
  6. 6.
    Donoso E, Adler NL, Friedberg CK (1964) Unusual forms of second degree atrioventricular block, associated with Morgagni-Adams-Stokes syndrome. Am Heart J 67:150–157PubMedCrossRefGoogle Scholar
  7. 7.
    Dhingra RC, Denes P, Wu D et al (1974) The significance of second degree atrioventricular block and bundle branch blok. Observation regarding site and type of block. Circulation 49:638–646PubMedCrossRefGoogle Scholar
  8. 8.
    Strasberg B, Amat-y-Leon F, Dhingra RC et al (1981) Natural history of chronic second degree atrioventricular nodal block. Circulation 63:1043–1049PubMedCrossRefGoogle Scholar
  9. 9.
    Clarke M, Sutton R, Ward D et al (1991) Recommendations for pacemaker prescription for symtomatic bradycardia. Report of a working party of the British Pacing and Electrophysiology Group. Br Heart J 66:185–191CrossRefGoogle Scholar
  10. 10.
    Shaw DB, Kekwick C, Veale D et al (1985) Survival in second degree atrioventricular block. Br Heart J 53:587–593PubMedCrossRefGoogle Scholar
  11. 11.
    Connelly DT, Steinhaus DM (1996) Mobitz type I atrioventricular block: an indication for permanent pacing? Pacing Clin Electrophysiol 19:261–264PubMedCrossRefGoogle Scholar
  12. 12.
    Barold SS (1998) Indication for pacing in acquired atrioventricular block: the 1991 ACC/AHA guidelines should be revised. In: Barold SS, Mugica J (eds) Recent advances in cardiac pacing: goals for the 21st century. Futura, Armonk, NY, pp 115–121Google Scholar
  13. 13.
    Rardon DP, Miles WM, Mitrani RD et al (1995) Atrioventricular block and dissociation. In: Zipes DP, Jalife J (eds) Cardiac electrophysiolgy: from cells to bedside. Saunders, Philadelphia, pp 935–942Google Scholar
  14. 14.
    Kastor JA (1994) Atrioventricular block. In: Kastor JA (ed) Arrhythmias. Saunders, Philadelphia, pp 145–200Google Scholar
  15. 15.
    Schoeller R, Andersen D, Buttner P et al (1993) First or second degree atrioventricular block as a risk factor in idiopathic dilated cardiomyopathy. Am J Cardiol 71:720–726PubMedCrossRefGoogle Scholar
  16. 16.
    Skinner NS Jr, Mitchell JH, Wallace AG et al (1963) Hemodynamic effects of altering the timing of atrial systole. Am J Physiol 205:499–503PubMedGoogle Scholar
  17. 17.
    Ishikawa T, Kimura K, Miyazaki N et al (1992) Diastolic mitral regurgitation in patients with first degree atrioventricular block. Pacing Clin Electrophysiol 15:1927–1931PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • R. Cazzin
    • 1
  • P. Golia
    • 1
  • G. Di Fonzo
    • 1
  1. 1.Unità Operativa CardiologicaOspedale di PortogruaroVeniceItaly

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