Third-Degree Atrioventricular Block in Sinus Rhythm Not Due to Transient Causes

This protocol covers third-degree atrioventricular block in a patient who is in sinus rhythm — without atrial fibrillation — where the block is not due to transient causes that can be corrected and prevented.

Clinical Situation

When third-degree AVB occurs in a patient in sinus rhythm and the cause is permanent or paroxysmal rather than reversible, pacing is indicated irrespective of whether the patient is currently symptomatic. Transient, correctable causes are specifically excluded from this protocol's scope.

Treatment Approach

Management involves cardiac pacing — permanent pacemaker implantation — with the choice of pacing configuration playing a central role in preventing complications and preserving quality of life. The full protocol specifies which configuration is preferred and why.

Instant Access to Structured Evidence-Based Regimens

References

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.
Pacing is not recommended in patients with AVB due to transient causes that can be corrected and prevented.
In patients with AVB, DDD should be preferred over single-chamber ventricular pacing to avoid pacemaker syndrome and to improve quality of life.

DOI: 10.1093/eurheartj/ehab364

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