High Grade Atrioventricular Block Presenting with Cardiac Arrest

Olusegun Sheyin^1, , Margaret Mgbemena¹, Oluwabomilasiri Magnus-Lawson¹, Luqman Salahudeen¹, Bredy Pierre-Louis² and Damian Kurian²

¹Department of Medicine, Harlem Hospital Center in Affiliation with Columbia University College of Physicians and Surgeons

²Division of Cardiology Department of Medicine, Harlem Hospital Center in Affiliation with Columbia University College of Physicians and Surgeons

Cite this paper:
Olusegun Sheyin, Margaret Mgbemena, Oluwabomilasiri Magnus-Lawson, Luqman Salahudeen, Bredy Pierre-Louis and Damian Kurian. High Grade Atrioventricular Block Presenting with Cardiac Arrest. American Journal of Cardiovascular Disease Research. 2014; 2(2):31-35. doi: 10.12691/ajcdr-2-2-4

Abstract

Introduction: Atrioventricular block usually does not cause cardiac arrest because of the development of an escape rhythm which maintains cardiac output. We report a case of high grade AV block presenting with cardiac arrest. Case Description: A 74-year-old man with past medical history of hypertension, dyslipidemia and a recent stroke was brought to the emergency room after a cardiac arrest, with pulseless electrical activity as the initial rhythm. Cardiopulmonary resuscitation was performed with return of spontaneous circulation after five minutes. On examination, he was unresponsive, with heart rate of 33 beats per minute, blood pressure of 108/51mmHg, normal heart sounds and clear lungs. He was given a total of 2mg of atropine, following which he was started on dopamine infusion, with no significant increase in heart rate. His electrocardiogram showed high grade AV block with ventricular rate of 30 beats per minute. An assessment of cardiac arrest due to severe conduction disease, with no evidence of acute coronary syndrome was made. A trans-venous pacemaker was inserted with improvement in the patient’s blood pressure and mental status. EKG revealed demand ventricular pacing with 100% ventricular capture. By the third day of admission, he was fully awake and following simple commands, but he remained pacemaker-dependent with no subsidiary rhythm. He had a dual chamber permanent pacemaker inserted without complication. Discussion: In advanced (high grade) second degree AV block, there is failure of conduction of two or more consecutive P waves. High grade AV block may be asymptomatic, or it may present with symptoms of hypoperfusion due to reduced cardiac output. Conclusion: This case describes a not previously reported presentation of high grade AV block with cardiac arrest and is in agreement with the 2008 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) device guidelines recommendations for permanent pacemaker insertion.

Keywords:
atrioventricular cardiac arrest escape rhythm heart block pacemaker

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References:

[1]	Wenckebach KF, “Zur Analyse der unregelmässigen Pulses,” Ztschr klin Med, 36. 181. 1899.
[2]	Mobitz W, “Über die unvollständige Störung der Erregungsüberleitung zwischen Vorhof und Kammer des menschlichen Herzens,” Z Gesamte Exp Med, 41. 180. 1924.
[3]	Marin H. Kollef, Timothy J. Bedient, Warren Isakow. The Washington manual of critical care, Lippincott Williams & Wilkins, Philadelphia. 2008. p. 128
[4]	Wagner, GS. Marriott’s Practical Electrocardiography (12th edition), Lippincott Williams & Wilkins, Philadelphia. 2014.
[5]	Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM, “Natural history of chronic second-degree atrioventricular nodal block,” Circulation, 63(5). 1043-9. 1981.
[6]	Narula OS. Conduction disorders in the AV transmission system. Cardiac Arrhythmias, Grune and Stratton, New York 1973. p.259.
[7]	Peuch P. The value in intracardiac recordings. Cardiac Arrhythmias, Saunders, Philadelphia 1975. p.81.
[8]	Puech P, Wainwright RJ, “Clinical electrophysiology of atrioventricular block,” Cardiol Clin, 1. 209. 1983
[9]	Dhingra RC, Denes P, Wu D, et al, “The significance of second degree atrioventricular block and bundle branch block. Observations regarding site and type of block,” Circulation, 49. 638. 1983
[10]	Strasberg B, Amat-Y-Leon F, Dhingra RC, et al, “Natural history of chronic second-degree atrioventricular nodal block,” Circulation 63. 1043. 1981
[11]	Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.