Treatment of Second-Degree Atrioventricular Block, Mobitz Type 2
Second-degree atrioventricular (AV) block Mobitz Type 2 is a conduction disorder with a recognised risk of progression towards higher-degree or complete AV block and severe haemodynamic compromise — even when the patient is currently asymptomatic.
Clinical Approach
Because of the risk of progression, current guideline recommendations call for definitive rhythm management in all patients with confirmed Mobitz Type 2 block in the absence of a reversible cause, regardless of symptom status. The nature and configuration of the preferred intervention are central to the decision algorithm.
The primary intervention involves a permanent device-based rhythm solution. Guidance addresses not only whether to intervene, but also which pacing configuration is preferred — a distinction that carries meaningful clinical implications for quality of life and the avoidance of syndrome related to pacing mode selection.
The full protocol specifies the intervention type, preferred device configuration, and additional decision criteria.
References
DOI: 10.1093/eurheartj/ehab364
- In the absence of a reversible cause, due to the risk of occurrence of severe symptoms and/or possible progression towards a more severe or complete AVB, patients should receive a pacemaker even in the absence of symptoms.
- Pacing is indicated in patients in SR with permanent or paroxysmal third- or second-degree type 2, infranodal 2:1, or high-degree AVB, irrespective of symptoms.
- In patients with AVB, DDD should be preferred over single-chamber ventricular pacing to avoid pacemaker syndrome and to improve quality of life.
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