First degree AV block surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Mohammed Salih, M.D., Cafer Zorkun, M.D., Ph.D. [3], Raviteja Guddeti, M.B.B.S. [4]

Overview

Common factors associated with placement of permanent pacemaker include presence or absence of symptoms, level of atrioventricular block, unstable scaped ventricular rhythm with rapid progression to complete heart block. First-degree AV block is typically a benign condition that do not progress suddenly to complete heart block. Placement of permanent pacemaker is reserved for the condition that symptomatic First-degree AV block affects quality of life as well as evidence of atrioventricular block in neurologic conditions with Lamin A/C mutation ( limb girdle, emery dreifuss, muscular dystrophies).

Permanent pacemaker implantation

Common factors associated with placement of permanent pacemaker include:

Presence or absence of symptoms
Level of atrioventricular block
Unstable scaped ventricular rhythm with rapid progression to complete heart block

First-degree AV block is typically a benign condition that do not progress suddenly to complete heart block.
Placement of permanent pacemaker is reserved for the condition that symptomatic First-degree AV block affects quality of life.
First-degree AV block in patients with Lamin A/C mutation may be predictive for ventricular arrhythmia in future.
Permanent pacing with defibrillator capacities is reasonable in patients with Lamin A/C mutation with evidence of atrioventricular block, regardless the presence or absent of symptoms.^[1]

Management of First-degree AV block

Atrioventricular block

Profound First-degree AV block

Symptoms

Yes

No

Permanent pacing (class 2a)

Lamin A/C, neuromascular disease

Yes

No

Lamin A/C

Observation

Yes

No

Permanent pacing (class3:Harm)

Pemanent pacing (class2a)

Neuromascular disease

Yes

Permanent pacing (class2b)

The above algorithm adopted from 2018 AHA/ACC/HRS Guideline^[2]

Recommendations for permanent pacemaker implantation for bradycardia associated atrioventricular block

Recommendations for permanent pacemaker implantation for bradycardia associated atrioventricular block

(Class IIa, Level of Evidence B):

❑ In patients with Lamin A/C mutation such as limb girdle, emery dreifuss, muscular dystrophies, in the presence of prolonged PR interval>240 ms and LBBB ,permanent pacing with additional defibrillator therapy is recommended while life expectancy>1 year

(Class IIa, Level of Evidence C):

❑Permanent pacing is recommended in patients with symptomatic profound First-degree AV block when symptoms clearly related to atrioventricular block

(Class IIb, Level of Evidence C):

❑ In patients with neuromuscular disease such as myotonic dystrophy type 1 in the presence of prolonged PR interval>240 ms and QRS duration >120 ms or fascicular block, permanent pacing with additional defibrillator therapy is reasonable if life expectancy>1 year

The above table adopted from 2018 AHA/ACC/HRS Guideline^[2]

Contraindications of permanent pacemaker implantation for bradycardia associated atrioventricular block

Contraindications of permanent pacemaker implantation for bradycardia associated atrioventricular block

(Class III (Harm), Level of Evidence C):

❑ Permanent pacing is not recommended in patients with First-degree atrioventricular block or mobitz type 1 second degree atrioventricular block (wenchebache), or 2:1 atrioventricular block when the level of block is in atrioventricular node or symptoms are not related to atrioventricular block
❑Permanent pacing should not be implanted in asymptomatic patients with First-degree atrioventricular block or mobitz type 1 second degree atrioventricular block (wenchebache), 2:1 atrioventricular block or when the level of block is in atrioventricular node

The above table adopted from 2018 AHA/ACC/HRS Guideline^[2]

References

↑ Parks SB, Kushner JD, Nauman D, Burgess D, Ludwigsen S, Peterson A, Li D, Jakobs P, Litt M, Porter CB, Rahko PS, Hershberger RE (July 2008). “Lamin A/C mutation analysis in a cohort of 324 unrelated patients with idiopathic or familial dilated cardiomyopathy”. Am Heart J. 156 (1): 161–9. doi:10.1016/j.ahj.2008.01.026. PMC 2527054. PMID 18585512.
↑ ^2.0 ^2.1 ^2.2 Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). “2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society”. Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.

Template:WikiDoc Sources

[pmid18585512-1] Parks SB, Kushner JD, Nauman D, Burgess D, Ludwigsen S, Peterson A, Li D, Jakobs P, Litt M, Porter CB, Rahko PS, Hershberger RE (July 2008). “Lamin A/C mutation analysis in a cohort of 324 unrelated patients with idiopathic or familial dilated cardiomyopathy”. Am Heart J. 156 (1): 161–9. doi:10.1016/j.ahj.2008.01.026. PMC 2527054. PMID 18585512.

[KusumotoSchoenfeld2019-2] 2.0 ^2.1 ^2.2 Kusumoto, Fred M.; Schoenfeld, Mark H.; Barrett, Coletta; Edgerton, James R.; Ellenbogen, Kenneth A.; Gold, Michael R.; Goldschlager, Nora F.; Hamilton, Robert M.; Joglar, José A.; Kim, Robert J.; Lee, Richard; Marine, Joseph E.; McLeod, Christopher J.; Oken, Keith R.; Patton, Kristen K.; Pellegrini, Cara N.; Selzman, Kimberly A.; Thompson, Annemarie; Varosy, Paul D. (2019). “2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society”. Circulation. 140 (8). doi:10.1161/CIR.0000000000000628. ISSN 0009-7322.

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