Paroxysmal AV Block Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akash Daswaney, M.B.B.S[2]

Natural history most commonly includes recurrent unexplained syncope and presyncope. Complications such as sudden cardian death or indefinite periods of asystole may arise. Prognosis of intrinsic paroxysmal AV block is more dire than extrinsic idiopathic paroxysmal AV block or extrinsic vagal paroxysmal AV block.

• Paroxysmal AV Block is a poorly defined entity.
• The symptoms of paroxysmal AV block can develop at any age (with some studies suggesting a predominance in older individuals) and presents with symptoms such as recurrent unexplained syncope and presyncope, which further manifests on an ECG as intermittent and progressively increasing periods of asystole.

• Common complications of paroxysmal AV Block include asystole, complete AV Block and sudden cardiac death.
• Complications that can develop as a result of theophylline therapy are nausea, vomiting, abdominal pain, irritability, hallucinations, arrhythmias, acute lung injury and seizures.^[1]
• Complications that can develop as a result of cardiac pacing are procedural, component or biophysical interface related. These include hemothroax, pneumothorax,acute thromboembolism, arrhythmia, pericarditis, device battery failure, pulse generator circuit failure, wound dehiscence, erosion, pain and infection.^[2]

• Given the presence of an innate structural defect, there is an increase risk of progression to complete AV Block in patients with intrinsic AV block. Sparse literature suggest some correlation between length of asystole and increased severity.^[3]
• Given that extrinsic vagally mediated AV block is not associated with an innate conduction defect (seen in intrinsic paroxysmal AV block) and is at the level of the AV node, it is considered benign. ^[4]
• Given the absence of structural heart disease, the paroxysmal nature of the episodes and the low probability of progression into more severe forms of AV block, extrinsic idiopathic paroxysmal AV block has a good prognosis. ^[5]

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