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Paroxysmal AV Block

April 18, 2014

In the setting of a normal resting 12 lead ECG: 

  1. Vagal: PP slows, or PR increases before or around block – pacing may stop you fainting (1, 2 ,3)
     
  2. Idiopathic: no change in PP or PR interval – pacing will stop you fainting (4)
     
  3. IntraHisian disease: PAVB begins with a pause (PAC or PVC) – pacing will stop you fainting and may save your life (5, 6)
 
References:
 
  1. Brignole, M., Menozzi, C., Moya, A., Andresen, D., Blanc, J. J., Krahn, A. D., et al. (2012). Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation125(21), 2566–2571. doi:10.1161/CIRCULATIONAHA.111.082313
  2. Brignole, M., Donateo, P., Tomaino, M., Massa, R., Iori, M., Beiras, X., et al. (2014). Benefit of pacemaker therapy in patients with presumed neurally mediated syncope and documented asystole is greater when tilt test is negative: an analysis from the third international study on syncope of uncertain etiology (ISSUE-3). Circulation: Arrhythmia and Electrophysiology7(1), 10–16. doi:10.1161/CIRCEP.113.001103
  3. Sutton, R., Ungar, A., Sgobino, P., Russo, V., Massa, R., Melissano, D., et al. (2014). Cardiac pacing in patients with neurally mediated syncope and documented asystole: effectiveness analysis from the Third International Study on Syncope of Uncertain Etiology (ISSUE-3) Registry. Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology16(4), 595–599. doi:10.1093/europace/eut323
  4. Brignole, M., Deharo, J. C., De Roy, L., Menozzi, C., Blommaert, D., Dabiri, L., et al. (2011). Syncope due to idiopathic paroxysmal atrioventricular block: long-term follow-up of a distinct form of atrioventricular block. Journal of the American College of Cardiology, 58(2), 167–173. doi:10.1016/j.jacc.2010.12.045
  5. Lee, S., Wellens, H. J. J., & Josephson, M. E. (2009). Paroxysmal atrioventricular block. Heart Rhythm : the Official Journal of the Heart Rhythm Society, 6(8), 1229–1234. doi:10.1016/j.hrthm.2009.04.001
  6. el-Sherif, N., & Jalife, J. (2009). Paroxysmal atrioventricular block: Are phase 3 and phase 4 block mechanisms or misnomers? Hrthm, 6(10), 1514–1521. doi:10.1016/j.hrthm.2009.06.025 

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