First Degree Heart Block Management
- Asymptomatic patients: Require no therapy. “Pacemaker syndrome” patients, whose quality of life is affected by the disconcerting awareness of their own heartbeat, can have a permanent pacemaker implanted, but this is actually rare.
Second Degree Heart Block Management
- Asymptomatic Mobitz I patients: Require no treatment.
- Symptomatic Mobitz I patients: Can be treated with medicinal pacing of the ventricles (atropine, dopamine) or temporary cardiac pacemaking in cases of myocardial infarction to mitigate the mortality risk associated with the occurrence of Mobitz 1 at the time of myocardial infarction.
In Mobitz I patients who do not have this arrhythmia from a reversible cause and are symptomatic, a permanent pacemaker can be implanted.
Third Degree Heart Block Management
In many ways, management of third degree AV (complete) block is the same as for second degree Mobitz II AV block.
- Stable patients: Since ventricular escape rhythms are unreliable and unstable, patients should be monitored continuously in the event of deterioration. Any symptoms due to bradycardia should indicate the need for a permanent implantable pacemaker.
- Unstable Patients: Hemodynamic instability mandates urgent, emergency treatment with atropine and a temporary cardiac pacemaker (transcutaneous or transvenous). Dopamine can be given for those with hypotension. Once stability is achieved clinically, a permanent pacemaker can be implanted.