How is first-degree atrioventricular (AV) block treated?

Updated: Jan 06, 2020
  • Author: Jamshid Alaeddini, MD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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In general, no treatment is indicated for asymptomatic isolated first-degree atrioventricular (AV) heart block.

For patients with marked first-degree AV block (PR interval > 300 msec), however, several uncontrolled trials have demonstrated symptomatic improvement with placement of a dual-chamber pacemaker, though there is little evidence suggesting improved survival. [3] in patients with severe bradycardia or those with the possibility of progression to higher-degree AV block, medications (eg, atropine, isoproterenol) can be used in anticipation of insertion of a cardiac pacemaker.

Any associated condition (eg, myocardial infarction [MI], digitalis intoxication) should be treated appropriately. Significant electrolyte abnormalities should be corrected.

In patients with symptomatic first-degree AV block, discontinue medications with potential for AV block, if possible. Electrophysiology consultation may be indicated for patients with first-degree AV block and symptoms of syncope or heart failure.

In general, hospitalization specifically for first-degree AV block is not indicated. However, admission may be indicated for associated conditions (eg, MI). Patients with a marked first-degree AV block can present with symptoms similar to the pacemaker syndrome. [3] In these individuals, admission may be indicated.

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