What is the role of a pacemaker in the treatment of first-degree atrioventricular (AV) block?

Updated: Jan 06, 2020
  • Author: Jamshid Alaeddini, MD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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According to guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS), permanent pacemaker implantation is reasonable for first-degree AV block with symptoms similar to those of pacemaker syndrome or hemodynamic compromise (class IIa recommendation; level of evidence, B). [28] Additional ACC/AHA/HRS recommendations have been formulated for other patients with first-degree AV block, as follows.

Patients with first-degree AV block, with or without symptoms, may be considered for permanent pacemaker implantation if the block occurs in the setting of neuromuscular diseases such as myotonic muscular dystrophy, Erb dystrophy (limb-girdle muscular dystrophy), or peroneal muscular atrophy, because these patients may experience unpredictable progression of AV conduction disease ( class IIb recommendation, level of evidence, B).

Permanent pacemaker implantation is not indicated for asymptomatic first-degree AV block (class III recommendation; level of evidence, B).

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