Atrioventricular block medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2], Edzel Lorraine Co, DMD, MD[3]

Treatment goal is to remove the extrinsic causes and treat reversible intrinsic causes. Drugs used in the treatment of AV nodal blocks include atropine, isoproterenol, theophylline, antibiotics treatment for lyme disease and treatment of ischemia. A permanent pacemaker is indicated for symptomatic bradycardia due to advanced second- or third-degree heart blocks.

• Permanent pacemaker is the treatment of choice for atrioventricular blocks and does not require concomitant pharmacologic treatment.
• Drugs that block AV nodal conduction must be discontinued.

• Atropine may be administered in emergency management of atrioventricular block to improve AV conduction until a temporary transcutaneous or transvenous pacemaker is inserted. However, atropine can potentially worsen the conduction if the block is in the bundle of His.

• Anti-cholinergic drug
• Improves AV conduction
• Insufficient doses can worsen the block

• Isoproterenol is a beta 1 and beta 2 receptor agonist
• Increases heart rate
• Ionotropic effect

• Patients with first degree AV block and Mobitz I can be managed at home and require a continuous follow-up with EKG or Holter monitoring to look for progression to a more severe type of heart block.

Second-degree atrioventricular block and third-degree atrioventricular block is considered an absolute contraindication to the use of the following medications:

• Amiodarone
• Carvedilol
• Fingolimod
• Propafenone
• Timolol

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