First-degree atrioventricular block (AV block) is a disease of the electrical conduction system of the heart in which electrical impulses conduct from the cardiac atria to the ventricles through the atrioventricular node (AV node) more slowly than normal. First degree AV block does not generally cause any symptoms, but may progress to more severe forms of heart block such as second- and third-degree atrioventricular block. It is diagnosed using an electrocardiogram, and is defined as a PR interval greater than 200 milliseconds.[1] First degree AV block affects 0.65-1.1% of the population with 0.13 new cases per 1000 persons each year. Show Causes[edit]The most common causes of first-degree heart block are AV nodal disease, enhanced vagal tone (for example in athletes), myocarditis, acute myocardial infarction (especially acute inferior MI), electrolyte disturbances and medication. The medications that most commonly cause first-degree heart block are those that increase the refractory time of the AV node, thereby slowing AV conduction. These include calcium channel blockers, beta-blockers, cardiac glycosides, and anything that increases cholinergic activity such as cholinesterase inhibitors.[2] Diagnosis[edit]In normal individuals, the AV node slows the conduction of electrical impulses through the heart. This is manifest on a surface electrocardiogram (ECG) as the PR interval. The normal PR interval is from 120 ms to 200 ms in length. This is measured from the initial deflection of the P wave to the beginning of the QRS complex.[3] In first-degree heart block, the diseased AV node conducts the electrical activity more slowly. This is seen as a PR interval greater than 200 ms in length on the surface ECG. It is usually an incidental finding on a routine ECG.[4] First-degree heart block does not require any particular investigations except for electrolyte and drug screens, especially if an overdose is suspected.[5] Treatment[edit]The management includes identifying and correcting electrolyte imbalances and withholding any offending medications. This condition does not require admission unless there is an associated myocardial infarction. Even though it usually does not progress to higher forms of heart block, it may require outpatient follow-up and monitoring of the ECG, especially if there is a comorbid bundle branch block. If there is a need for treatment of an unrelated condition, care should be taken not to introduce any medication that may slow AV conduction. If this is not feasible, clinicians should be very cautious when introducing any drug that may slow conduction; and regular monitoring of the ECG is indicated.[6] Prognosis[edit]Isolated first-degree heart block has no direct clinical consequences. There are no symptoms or signs associated with it. It was originally thought of as having a benign prognosis. In the Framingham Heart Study, however, the presence of a prolonged PR interval or first degree AV block doubled the risk of developing atrial fibrillation, tripled the risk of requiring an artificial pacemaker, and was associated with a small increase in mortality. This risk was proportional to the degree of PR prolongation.[7] A subset of individuals with the triad of first-degree heart block, right bundle branch block, and either left anterior fascicular block or left posterior fascicular block (known as trifascicular block) may be at an increased risk of progression to complete heart block.[8] See also[edit]
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External links[edit]How serious is a firstTraditionally, first-degree AV block has been considered a benign condition. However, epidemiologic data from the Framingham Study have shown that first-degree AV block is associated with increased risk of all-cause mortality in the general population.
What is a sinus rhythm 1st degree AV block?First-degree atrioventricular (AV) block is a condition of abnormally slow conduction through the AV node. It is defined by ECG changes that include a PR interval of greater than 0.20 without disruption of atrial to ventricular conduction. This condition is generally asymptomatic and discovered only on routine ECG.
What is the treatment for 1st degree AV block?In general, no treatment is required for first-degree AV block unless prolongation of the PR interval is extreme (>400 ms) or rapidly evolving, in which case pacing is indicated. Prophylactic antiarrhythmic drug therapy is best avoided in patients with marked first-degree AV block.
Does firstA first degree heart block is where there is split-second delay in the time that it takes electrical pulses to move through the AV node. First degree heart block does not usually cause any noticeable symptoms and treatment is rarely required.
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